Evidence Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Nov 19, 2021; 11(11): 937-953
Published online Nov 19, 2021. doi: 10.5498/wjp.v11.i11.937
Therapeutic termination of pregnancy and women’s mental health: Determinants and consequences
Ester di Giacomo, Rodolfo Pessina, Mario Santorelli, Daniele Rucco, Valeria Placenti, Francesca Aliberti, Fabrizia Colmegna, Massimo Clerici
Ester di Giacomo, Massimo Clerici, School of Medicine and Surgery, University Milan Bicocca, Monza 20900, Lombardy, Italy
Ester di Giacomo, Fabrizia Colmegna, Massimo Clerici, Department of Psychiatric, ASST Monza, Monza 20900, Lombardy, Italy
Rodolfo Pessina, Mario Santorelli, Francesca Aliberti, Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
Daniele Rucco, PhD Program in Psychology, Linguistics and Cognitive Neuroscience, University Milan Bicocca, Milano 20126, Lombardy, Italy
Valeria Placenti, Psychiatric Residency Training Program, University of Genova, Genova 16126, Liguria, Italy
Author contributions: Pessina R and di Giacomo E wrote the paper; Rucco D, Colmegna C, Santorelli M, Placenti V, Aliberti F and Clerici M collected data; All authors analyzed papers and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ester di Giacomo, MD, PhD, Academic Research, Doctor, School of Medicine and Surgery, University Milan Bicocca, Via Cadore 48, Monza 20900, Lombardy, Italy. ester.digiacomo@unimib.it
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: July 15, 2021
Revised: July 27, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: November 19, 2021
Processing time: 264 Days and 14.8 Hours
Abstract

The therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability. This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother. Socio-cultural and economic determinants could influence the desire for children and family planning in couples, as well as the use of effective contraception and the choice to perform an induced abortion. Also, pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP. Furthermore, the TToP is a reproductive event with an important traumatic burden, but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples. The aim of this review is to evaluate what demographic, reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women. Also, we will examine both positive and negative consequences of this procedure on women’s mental health, underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

Keywords: Therapeutic abortion; Women’s health; Depression; PostTraumatic stress disorder; Perinatal care; Psychiatry

Core Tip: The choice of having a therapeutic termination of pregnancy (TToP) is strictly personal and several demographic and reproductive factors may contribute. Women who have a TToP are more commonly affected by a previous mental disorder, which influences their mental outcomes after it. There is a higher prevalence of any axis I psychiatric disorder in women who choose for a TToP, but the correlation with personality disorders has been less examined. TToP seems to produce both positive and negative psychopathological effects on women and only a minority of women show psychiatric disorders after it, especially those with a previous psychiatric history.