(278) Maternal Morbidity Trends Among Abortion-Banned States Following Dobbs v. Jackson: An Interrupted Time Series Analysis

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Julie Trahan, MD, MSc (she/her/hers)

Maternal-Fetal Medicine Fellow
Columbia University
New York, NY, United States

Coauthor(s)

Gabriela F. Tessler, MD

Resident
Columbia University Medical Center
New York, NY, United States
YH

Yongmei Huang, DrPH, MD

Associate Research Scientist
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
JW

Jason D. Wright, MD

Professor of Obstetrics and Gynecology
Columbia University Irving Medical Center
New York, New York, United States
AF

Alexander M. Friedman, MD, MPH

Professor of Obstetrics and Gynecology
Columbia University Irving Medical Center
New York, New York, United States

Objective: The objective of this study was to evaluate trends in maternal morbidity among states with the most limited access to abortion following Dobbs v. Jackson, the United States Supreme Court Decision, which overruled Roe v. Wade, on June 24, 2022.

Study Design: States were characterized as abortion-banned based on categories established by the Center for Reproductive Rights. Six states with the most restrictive laws (classified as illegal) were selected for this study: Alabama, Kentucky, Louisiana, Mississippi, Missouri, and Oklahoma. Maternal morbidity data were obtained from the Centers for Disease Control (CDC) and Prevention Natality on CDC WONDER Online Database for each state from 2020 Q1 to 2024 Q2. Morbidity incidence per 1000 births was measured for each quarter. An interrupted time series analysis was conducted to compare changes in maternal morbidity for selected states, before and after Dobbs v. Jackson (2020 Q1-2022 Q1: pre-Dobbs, 2022 Q2-2022 Q4: transition period, 2023 Q1-2024 Q2: post-Dobbs).

Results: Data from 1,398,504 pregnancies were analyzed. The average maternal morbidity rate for all studied states was 13.5 per 1000 births over the study period. Pre-Dobbs, the overall morbidity rate increased between 2020 Q1 and 2022 Q1 (12.5 to 14.3 per 1000 births; baseline trend: β1=0.23, p=0.0002). Immediately post-Dobbs, the morbidity rate significantly decreased to 12.8 per 1000 births in 2023 Q1 (level change, β2=-1.24, p=0.01). The morbidity trends pre- and post-Dobbs did not change significantly (β3=-0.08, p=0.34), and the maternal morbidity rate continued to increase significantly post-Dobbs, to 14.0 per 1000 births in 2024 Q2 (β1+β3=0.15, p=0.02).

Conclusion: Our study findings signal an increase in the rate of maternal morbidity in states with abortion bans prior to and after the overturning of Roe v. Wade. This is particularly concerning in the setting of an overall trend of increasing maternal morbidity in the United States.