Abstract
Changes in abortion laws following the Dobbs v Jackson Women’s Health Organization decision may adversely impact pregnant people experiencing high-risk pregnancy complications. The dissertation: (1) estimated the pre-Dobbs prevalence and trends of six high-risk pregnancy-related complications and assessed the impact of the COVID-19 pandemic on hospital visit rates; (2) examined pre-Dobbs adverse outcomes among people presenting to the hospital with at least one of the high-risk complications under study; and (3) evaluated the impact of the Dobbs decision on hospital visit rates by state abortion policy and gestational age. Data came from the Healthcare Cost and Utilization Project State Emergency Department Database and State Inpatient Database. Six complications where pregnancy care may be affected by severe abortion restrictions were analyzed: ectopic pregnancy, molar pregnancy, preterm premature rupture of the membranes (PPROM), placental disorders, placental abruption, and chorioamnionitis. Pre-Dobbs, visit rates increased from 2018 to 2021 for ectopic pregnancy, PPROM, placental disorders, and placental abruption. Visit rates were slightly affected at the onset of the COVID-19 pandemic but were not sustained over time. Severe adverse outcomes were more frequent among minoritized racial groups, patients with chronic conditions, and those presenting with multiple complications. Post-Dobbs, rates for most complications continued to rise, with limited evidence of a differential impact in states that enacted severe abortion restrictions. These findings highlight ongoing increases in the prevalence of some high-risk pregnancy complications and persistent inequities in health outcomes. Continued monitoring is needed to evaluate the evolving effects of severe abortion restrictions on healthcare utilization and maternal and fetal health.