Maternal and Neonatal Outcomes of Supervised versus Unsupervised Medical Abortion: A Systematic Review and Meta-Analysis

Introduction: Unsafe abortion remains a persistent public health concern, with limited and inconsistent evidence on adverse pregnancy outcomes. This review aims to elucidate the prevalence and associated adverse maternal and newborn outcomes of unsupervised/supervised consumption of oral abortifacients during pregnancy. Methodology: The study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guideline. [PROSPERO registration: CRD42022357505]. Result: Fifteen studies (n=8,089) yielded the prevalence of unsupervised oral abortifacients use, while 79 studies (n=50,176), 10 unsupervised and 69 supervised assessed pooled adverse outcomes using a random effect model. Unsupervised abortifacients use was 35% [95%CI:23;50, Low quality evidence]. Maternal/neonatal adverse outcome were almost twice as common after unsupervised abortifacient use [19%(95%CI:14;26), Low quality evidence] compared with supervised abortifacient [9%(95%CI:10;16), Low quality evidence]. Higher maternal complications were observed in LMICs (13%), second-trimester pregnancies (15%), and single-drug oral regimens (29%). Neonatal outcomes were rarely reported. Conclusion: Easy availability of abortifacient drugs over-the-counter increase maternal and neonatal complications. Supervised first-trimester regimens are safer than unsupervised abortifacients or single drug abortifacients. There is dearth of evidence around safety of unsupervised abortifacients, highlighting the need for research on long-term physical and psychological impacts.