title: Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning.
abstract: OBJECTIVE
  Our purpose was to ascertain the effects of timing of conception on the risk of spontaneous abortion.
  
  
  METHODS
  To assess these effects, women who conceived while using natural family planning were identified in five centers worldwide between 1987 and 1993. Timing of conception was determined from 868 natural family planning charts that recorded day of intercourse and indices of ovulation (cervical mucus peak obtained according to the ovulation method and/or basal body temperature). Conceptions on days - 1 or 0 with respect to the natural family planning estimated day of ovulation were considered to be "optimally timed," and all other conceptions were considered as "non-optimally timed." The rate of spontaneous abortions per 100 pregnancies was examined in relation to timing of conception, ages, reproductive history, and other covariates with bivariate and multivariate statistical methods.
  
  
  RESULTS
  There were 88 spontaneous abortions among 868 pregnancies (10.1%). The spontaneous abortion rate was similar for 361 optimally timed conceptions (9.1%) and 507 non-optimally timed conceptions (10.9%). However, among 171 women who had experienced a spontaneous abortion in a prior pregnancy, the rate of spontaneous abortion in the index pregnancy was significantly higher with non-optimally timed conceptions (22.6%) as compared with optimally timed conceptions (7.3%). This association was not observed among 697 women with no history of pregnancy loss. The adjusted relative risk of spontaneous abortion among women with non-optimally timed conceptions and a history of pregnancy loss was 2.35 (95% confidence intervals 1.42 to 3.89). The excess risk of spontaneous abortion was observed with both preovulatory and postovulatory conceptions.
  
  
  CONCLUSIONS
  Overall, there is no excess risk of spontaneous abortion among the pregnancies conceived during natural family planning use. However, among women with a history of pregnancy loss, there is an increased risk of spontaneous abortion associated with preovulatory or postovulatory delayed conceptions.
authors.affiliation: Department of Population Dynamics, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Gray
authors.forename: J L
authors.initials: JL
authors.lastname: Simpson
authors.forename: R T
authors.initials: RT
authors.lastname: Kambic
authors.forename: J T
authors.initials: JT
authors.lastname: Queenan
authors.forename: P
authors.initials: P
authors.lastname: Mena
authors.forename: A
authors.initials: A
authors.lastname: Perez
authors.forename: M
authors.initials: M
authors.lastname: Barbato
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D016922:Cellular Senescence; D016009:Chi-Square Distribution; D005193:Family Planning Services; D005260:Female; D005306:Fertilization; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010060:Ovulation; D010061:Ovulation Detection; D010063:Ovum / Q000502:physiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D013094:Spermatozoa / Q000502:physiology; D013997:Time Factors