Pregnancy Outcomes at a Safety Net Hospital in Atlanta, Georgia, After Changes to Abortion Legislation [ID 2683629

Abstract

INTRODUCTION: On July 20, 2022, Georgia’s House Bill 481 (HB 481) went into effect for the first time since it passed state legislature in March 2019. House Bill 481 is an abortion ban in the presence of fetal cardiac activity. To date, no study has explored the law’s effects on key clinical indicators of maternal morbidity and mortality. The purpose of this study is to examine whether enactment of HB 481 has been associated with changes pregnancy-related morbidity at a safety net hospital in Atlanta, Georgia. METHODS: We are using an interrupted time series retrospective study design to evaluate trends in pregnancy complications at Grady Memorial Hospital between July 2021 and August 2023. The Emory IRB has approved this study. RESULTS: Of the 4,886 encounters linked to pregnancy outcomes included, 2,299 occurred in the year prior to enactment of HB 481 versus 2,587 in the year after. Preliminary crude data analysis demonstrated increases in rare outcomes post-enactment period compared to the pre-enactment period, specifically risk of progression to sepsis among those with preterm prelabor rupture of membranes (0.080 versus 0.061) and maternal intensive care unit admission (0.0085 versus 0.0070). There were no significant changes in the overall rate of delivery or encounters for miscarriage and a decrease in overall composite risk of severe maternal morbidity events (0.061 versus 0.074). CONCLUSION: In this rapidly changing legal landscape and with many laws similar to HB 481 being enacted in states across the United States, it is essential to continue to document the direct health effects of restrictive abortion policy on pregnancy outcomes.