Changes in pregnancy outcomes among high-risk pregnancies post-Dobbs: An interrupted time series analysis of hospital discharge data
Awarded 2023
High-risk pregnancy care, post-Dobbs
Suzanne Bell, PhD, MPH
Johns Hopkins University

This project aims to produce first-of-its-kind population-based evidence of the consequences of abortion bans on pregnancy care for high-risk pregnancies. Specifically, our proposed research will quantitatively evaluate the impact of abortion bans on pregnancy care among high-risk pregnancies following the Dobbs decision using comprehensive state-level monthly hospitalization data from 11 states (7 affected and 4 unaffected) for 2018 through 2022 to inform institutional and public policy. Our specific aims are to: 1) understand how abortion bans impact pregnancy care among hospitalized high-risk pregnancies involving lethal congenital anomalies (i.e., conditions likely to lead to death in utero or 28 days of birth) or genetic disorders not compatible with postnatal life; and 2) understand how abortion bans impact maternal outcomes via changes in pregnancy care among hospitalized high-risk pregnancies for whom intervention to end the pregnancy is medically indicated (e.g., ectopic pregnancy, molar pregnancy, incomplete miscarriage, pre-viable PPROM, advanced cervical dilation pre-viability, pre-viable severe preeclampsia with HELLP syndrome, among others). Using causal inference techniques, we will produce rigorous, empirical findings to demonstrate change in the proportion of high-risk pregnancies ending in termination (Aim 1) or maternal morbidity (including severe maternal morbidity or death) (Aim 2) associated with imposition of abortion bans in hostile states, a clear indication of changes in clinical practice that diverges from current evidence. This research is urgently needed as it informs time-sensitive decisions about reproductive health policy that will be determined at the institutional and state level over the next few years.