Ectopic pregnancy: their growth is linked to pelvic inflammatory disease and smoking

The incidence (number of new cases per year) of ectopic pregnancies in women without contraception has increased by 17% between 1992 and 2002, probably due to the increase in chlamydia and / or smoking, indicates study in Auvergne and extrapolated to the whole of France.
Since the mid-1980s, studies have shown a stabilization in the incidence of ectopic pregnancies in France, remember Dr. Joel Coste of Bicetre Hospital in Gentilly (Val-de-Marne, AP-HP) and colleagues.

However, they believe that this stagnation can be misleading because the case "with contraception," they describe as "contraceptive failure" and the case "without contraception," they describe as "reproductive failures" have not been analyzed separately.

To clarify the situation, the authors analyzed the register of ectopic pregnancies in Auvergne (women aged 15 to 44 years), distinguishing the two types of cases.

The study period, the overall rate of ectopic pregnancies decreased slightly, from 96.4 per 100,000 women in 1992 to 95.3 per 100,000 in 2002.

However, the researchers found two opposing trends in the context of pregnancy. After adjustment for age group, ectopic pregnancies have increased by 17% in women without contraception and were reduced by 29% of those using contraception.

The increase was particularly marked (53.7%) in the group of women without contraception aged 30 to 34 years.

For Joël Coste and colleagues, such an increase was expected, due to the increased frequency of Chlamydia trachomatis (23% between 1998 and 2002) and the increase in smoking among women of reproductive age. Indeed, these two factors are responsible for about 60% of ectopic pregnancies, they point out.

As for the decrease in the incidence of ectopic pregnancies resulting from contraceptive failure, they explained by a parallel reduction in the use of IUDs.

"The consequences of ectopic pregnancy on female fertility are serious" (infertility for 40% of women and 30% for recurrence, two years later). It is therefore necessary to carry out prevention campaigns Chlamydia trachomatis and inform women about the harmful effects of tobacco, the authors conclude.