Organ system-specific trends in congenital anomaly admissions following Texas senate bill 8.

Abstract

Background: Following implementation of Texas Senate Bill 8 (SB8), which bans abortions after approximately six weeks of gestation, increases in infant admissions have been observed, particularly among those with congenital anomalies.

Purpose: To evaluate changes in admissions and operative needs among newborns with congenital anomalies in Texas, stratified by organ system.

Methods: Retrospective analysis of the Texas Inpatient Public Use Data File, comparing pre- (Q1 2020 - Q2 2021) and post-SB8 (Q3 2021 - Q2 2024). Interrupted time series analyses assessed trends in total and operative admissions. Mortality was compared across one-year pre- and post-SB8 periods using Fisher's exact tests.

Results: Operative congenital anomaly admissions declined prior to SB8 (-86.5 admissions/year) but increased post-SB8 (+32.3 admissions/year). Operative needs varied by organ system; digestive anomalies had the highest operative intensity (53.6%). Temporal trends were heterogeneous, with variable changes across systems including declines in circulatory anomalies. Significant mortality changes included increased overall and operative mortality in circulatory anomalies (overall: P < 0.0001; operative: P < 0.0001), increased overall mortality in respiratory anomalies (P = 0.030), and decreased non-operative mortality in nervous system anomalies (P = 0.023), although most rates were stable.

Conclusions: Newborn congenital anomaly admissions increased in the period following SB8, coinciding with a reversal of declining operative volumes. Operative intensity and temporal trends varied substantially by organ system. Mortality remained low overall but increased notably in circulatory and respiratory categories. These findings underscore the importance of organ system-specific evaluation of outcomes following reproductive policy changes.

Level of evidence: III.