IMPACT OF DOBBS ON SEVERE EARLY PREGNANCY MORBIDITY AT AN ACADEMIC HOSPITAL IN UTAH

Abstract

Objectives

We evaluated the relationship between Dobbs v Jackson Women’s Health Organization and severe early pregnancy morbidity (SEPM) in pregnancies less than 24 weeks.

Methods

We identified pregnant patients at University of Utah hospital from January 2017 to December 2023 with diagnosis codes, blood product administration records, or intensive care transfer records indicating SEPM at less than 24 weeks. We defined SEPM using CDC severe maternal morbidity (SMM) diagnosis codes, ACOG/SMFM SMM criteria, or abortion-related morbidity including hemorrhage, pelvic infection, or damage to pelvic organs. We reviewed records to verify the presence of SEPM and assessed preventability using the Alliance for Innovation on Maternal Health SMM review form. We performed an interrupted time series analysis comparing the pre- and post-Dobbs rate of SEPM per 10,000 pregnancies per month and the rate of preventable events per 100 SEPM events per quarter. A sensitivity analysis excluded years affected by the COVID-19 pandemic.

Results

At baseline, we saw 16 SEPM events per 10,000 pregnancies (95% CI, 10.7-20.4). Prior to Dobbs, the rate of SEPM declined by 0.03 events per 10,000 pregnancies each month (-0.14, 0.10). Immediately following Dobbs, we found a non-significant increase in severe early pregnancy morbidity of 1.0 event per 10,000 pregnancies (-5.4, 7.4) and an additional monthly decline of -0.1 severe morbidity events per 10,000 pregnancies (-0.50, 0.34). An increase in proportion of preventable SEPM was noted immediately following Dobbs of 18 preventable events per 100 SEPM events (6.7, 29.5).

Conclusions

Following the Dobbs decision, overall rate of SEPM events did not increase, though the rate of preventable events increased.