S.E. Peiffer1, K. Hosek2, S. Mehl1, L. Cheng3, T.C. Lee1,2, S.G. Keswani1,2, A. King1,2 1Baylor College Of Medicine, Houston, TX, USA 2Texas Children’s Hospital, Houston, TX, USA 3Virginia Commonwealth University, Richmond, VA, USA
Introduction: The ban on early abortion in Texas in September 2021 may demonstrate how patterns of care of neonates and infants with congenital anomalies might change following the US Supreme Court’s June 2022 decision to overturn Roe v Wade. We aim to assess changes in the burden of care of congenital anomalies in neonates following enactment of Texas Senate Bill (SB8), which prohibits abortions following detection of a fetal heartbeat.
Methods: We performed a retrospective population-based database study using the Texas Inpatient Public Use Data File (TIPUDF) from July 2020 to December 2022. Data was reported annually by quarters. We define pre-enactment as July 2020 to June 2021, enactment as July 2021 to June 2022 and post-enactment as July 2022 to June 2023. ICD-10 diagnostic codes were used to identify congenital anomalies. Patients transferred to an outside hospital were excluded to avoid systematic double-counting. Demographics, total cost, and mortality were collected. Descriptive statistics were performed.
Results: 1,149,242 inpatient admissions for neonates and infants in Texas with 201,782 admissions for patient with CA between July 2020 and June 2023 were identified. Pre-enactment, there were a median of 89,736 (IQR 88,614-90,857) inpatient admissions per quarter of which 15,589 (IQR 15,527-15,650; 17.4%) had CA diagnoses with a median cost of $5037 (IQR $3,465-$8,938) per admission. During enactment, there were a median of 96,682 (IQR 93,055-100,309) inpatient admissions per quarter with 16,743 (IQR 16,554-16,931; 17.3%) admissions with CA diagnoses with a median cost of $5,546 (IQR $3,786-$11,008) per admission. Post-enactment, there were a median of 100,232 (IQR 95,870-104,594) inpatient admissions per quarter with an increase to 18,226 (IQR 18,123-18,329; 18.2%) with CA diagnoses with a median cost $5,896 (IQR $3,994-$11,676) per admission. While mortality was higher compared to the population without CA at all phases, mortality in admissions with CA decreased following enactment of SB8 (% CA admissions: pre-enactment 1.09% vs enactment 1.01% vs post-enactment 0.85%; p< 0.0001).
Conclusion: The 2021 Texas law banning abortion in early pregnancy (SB8) is associated with an increase in the number of admissions of neonates and infants with congenital anomalies. During the enactment of SB8, the number of admissions increased by 1,900 per quarter, with the most pronounce increased noted following enactment.