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CME Credit Offered
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Abstract Award
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Poster Session 1

(188) Maternal Mortality According to State Abortion Legislation Following the Supreme Court Dobbs v. Jackson Ruling

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Emily Nuss, MD (she/her/hers)

    Maternal-Fetal Medicine Fellow
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, VA, United States

    • Coauthor(s)

  • MI

    Mari Iwasaki, BA

    Ross University School of Medicine
    Miramar, Florida, United States

  • Lindsay S. Robbins, MD, MPH

    Fellow
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, Virginia, United States

  • PY

    Peggy Ye, MD, MPH

    MedStar Washington Hospital Center
    Washington, District of Columbia, United States

  • George R. Saade, MD (he/him/his)

    Professor and Chair, Associate Dean for Women's Health Obstetrics and Gynecology
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, Virginia, United States

  • Tetsuya Kawakita, MD, MS

    Associate Professor
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, VA, United States

Objective:
Following the 2022 Dobbs v Jackson United States Supreme Court case, many states passed legislation limiting abortion access. We assessed how maternal mortality rates (MMR) were affected by the ruling, accounting for the coronavirus (COVID-19) pandemic.

Study Design:
This was a difference-in-difference (DID) analysis using data from CDC WONDER (Center for Disease Control and Prevention, Wide-ranging ONline Data for Epidemiologic Research) from January 2018 to December 2023. We split this timeframe into three periods: pre-COVID (Jan 2018 to Feb 2020), pandemic (Mar 2020 to Jun 2022), and post-Dobbs (Jul 2022 to Dec 2023). We classified U.S. states as either abortion-restrictive (AR) or abortion-supportive (AS) based on their legislation at the time of this analysis. The primary outcome was maternal mortality, defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy.” We fitted generalized estimating equations with a Poisson distribution and a log link function to calculate DID estimates with 95% confidence intervals (95% CI).





Results:
Of 16,417,081 births included in this analysis, 5,740,974 were in AR states and 10,676,107 were in AS states. Compared to the pre-COVID period, the pandemic had a higher MMR in both AR states (15.1 per 100,000 births; 95% CI 10.6, 19.6) and AS states (5.6 per 100,000 births; 95% CI 1.3, 9.9). The increase in MMR during COVID-19 was greater in AR states (DID 9.5 per 100,000 births; 95% CI 3.3, 15.7). Compared to the pre-COVID period, the post-Dobbs period was not associated with a higher MMR in AR states (1.3 per 100,000 births; 95% CI -4.6, 7.2) or AS states (1.3 per 100,000 births; 95% CI -1.3, 3.9).

Conclusion:
MMR were consistently higher in AR states compared to AS states. COVID-19 exacerbated this difference, but the gap did not increase following the Dobbs ruling. These findings highlight the disparities in pregnancy outcomes across the US, underscoring the need for policies that address these differences.