Scientists are questioning the reliability and ethics of tests to detect abortion drugs in biological samples

‘Abortion tests’ developed in Poland spark concern

Scientists are questioning the reliability and ethics of tests to detect abortion drugs in biological samples

Tests under development in Poland that are designed to detect abortion drugs in biological samples are raising scientific and ethical concerns among scientists.

It is not clear to what extent such tests are being used by judicial authorities in Poland, where abortion is restricted by law in most circumstances. But researchers question whether the tests are ready to be used to determine pregnancy outcomes. They also warn that such tests have the potential to embolden prosecutors in Poland and other countries with restrictive laws on abortion — and to discourage women there from seeking safe reproductive care.

“The introduction of ‘abortion tests’ to probe pregnancy outcomes can be perceived as infringements on privacy and reproductive rights, highlighting the potential for science to be misused for political ends,” say chemists Dominika Czerwonka at the Institute of Bioorganic Chemistry of the Polish Academy of Sciences in Poznań and Szymon Sobczak at Adam Mickiewicz University in Poznań.

Abortion is one of several issues being hotly debated ahead of Poland’s parliamentary elections on 15 October. Under its current government, Poland — like the United States — has rolled back abortion rights. Since 2021, abortion has been permitted only in cases in which the pregnancy results from rape or the mother’s life or health are in danger.

Extent of use

The ‘abortion tests’ stoked controversy after The New York Times reported on them last month.

The tests are described in two scientific papers published by researchers in Poland in 2022. The papers report the detection of the drugs mifepristone and misoprostol — which are often used in combination to induce abortion or medically manage a miscarriage — in biological samples taken during the investigation of three suspected abortions in Poland. The researchers conclude that abortions took place and were induced by mifepristone or misoprostol^1,2.

The editorial office of the journal Molecules, which published both papers, told Nature that it has initiated an investigation into the papers in accordance with its complaints policy.

Paweł Szpot, a forensic toxicologist at Wrocław Medical University in Poland and lead author of the papers, stands by his team’s research and says that their motivations are scientific, not political. He says that he has openly studied this kind of testing for a decade and, in that time, has not encountered objections from other scientists. Szpot also says that the articles were peer reviewed without any concerns raised. “I look forward to the results of the investigation,” he says.

The extent to which such tests are being used by prosecutors is unclear. The New York Times reported that Wrocław’s regional prosecutor’s office said the tests have been used to investigate pregnancy outcomes in Poland. Nature contacted Poland’s 11 regional prosecutor’s offices; of the 4 that replied, one — in Łódź — said that it does not ask for such tests, and 3 were not able to confirm or share information about whether they ask for such tests as part of investigations. Poland’s national prosecutor’s office told Nature it had no information about the commissioning of such tests.

Under Polish law, women cannot be prosecuted for self-administering abortion pills, but anyone who assists a woman in obtaining the pills can be prosecuted.

Reports of the tests’ use in Poland are amplifying fears about seeking health care after self-administering abortion pills at home, says Kinga Jelińska, co-founder of Polish abortion-rights group Abortion Dream Team. “We immediately received a lot of e-mails and questions and phone calls and social-media messages,” she says.

Scientific questions

The tests described by Szpot and his colleagues rely on tandem mass spectrometry, a technique that enables chemical compounds in biological samples to be detected and quantified.

In one of the cases described in the papers in Molecules, Szpot and his colleagues detected mifepristone and its metabolites in a blood sample taken from a 22-year-old woman suspected of conducting an at-home abortion, using pills purchased online. In the two other cases, the researchers detected misoprostol acid — a metabolite of misoprostol — in samples of fetal and maternal tissue, including fetal liver and placental tissue.

Tandem mass spectrometry is an accepted technique in toxicology. But researchers say they would want to see much bigger studies of its use to detect abortion drugs in fetal or maternal samples before such tests are deemed reliable enough to be used to determine the outcome of a pregnancy.

“These are typical methodologies used in forensic toxicology,” says Felicia Green, a mass spectrometrist at the Rosalind Franklin Institute in Didcot, UK. But she adds that “the sample sizes used to ‘test’ their method are very small” and that “the papers do not suggest that the science is ready to be used for testing”. Czerwonka and Sobczak agree that the studies are too small to draw firm conclusions about the tests’ potential to determine whether someone had an abortion.

Szpot stands by the methods and conclusions of his papers. “These are methodological papers, not clinical trials,” he says. “When a new testing method is developed, it’s first validated, and then its efficacy is assessed,” he says.

He points to published studies by researchers in other nations that describe methods to detect the same abortion drugs in biological tissue, and that report the methods’ use in one-off investigations.

Medical legitimacy

Some researchers say that the reasons for using such tests are unethical, and reflect Poland’s restrictive abortion policies. “From my understanding, there is no legitimate medical reason why you would need to do a test to test for misoprostol or mifepristone,” says Sarah Roberts, an epidemiologist at Advancing New Standards in Reproductive Health, a research programme at the University of California, San Francisco. Jen Gunter, an obstetrician-gynecologist in San Francisco, agrees: “The only reason to know is prosecution.”

Szpot says that his work requires him to detect compounds in biological material that might be associated with death or medical symptoms, at the request of courts and prosecutors. “I am not a politician, I am a scientist, and I do my work in accordance with the current law in Poland,” he says.

Olga Wachełko at the Institute of Toxicology Research in Borowa and Marcin Zawadzki at Wrocław Medical University, co-authors of both of the Molecules papers, told Nature that they agree with Szpot’s statements and did not wish to comment further. “We categorically refuse to engage in politically charged debates because we firmly believe that science must remain untainted by politics,” they said. (Tomasz Jurek at Wrocław Medical University, co-author of one of the two papers, did not respond to Nature’s request for comment.)

In their papers, Szpot and his team write that mifepristone and misoprostol are used for illegal abortions in some countries, and that the increasing availability of these drugs and counterfeit abortion pills on the black market poses a public-health threat.

Gunter notes that clinical trials have proved the drugs to be safe, and says that the spectre of such tests being used by authorities could encourage more-dangerous forms of abortion. The drugs “both have an incredibly safe track record”, says Gunter. “My concern is if scientifically valid tests to detect misoprostol and/or mifepristone were developed, this would likely drive abortion further underground in places where it is illegal, possibly increasing the risks people are willing to take.”

doi: https://doi.org/10.1038/d41586-023-03129-9

This story originally appeared on: Nature - Author:Layal Liverpool