(1120) CDH and CCHD trends among states with vs without 20-week abortion bans from 2012-2018

Prior to recent legislature changes, many states enacted 20-week abortion bans. As related laws are implemented, understanding associated impacts may help guide future care. Congenital diaphragmatic hernia (CDH) and cyanotic congenital heart disease (CCHD) are commonly diagnosed at 20-week anatomy ultrasounds. We sought to examine trends in rates of CDH and CCHD diagnoses between states with and without 20-week abortion bans in the US during 2012-2018. 

Study Design:

A retrospective cohort study of all deliveries in the US between 2012-2018 using linked vital statistics data. Data analysis stratified CDH vs CCHD. States were categorized as those with or without a 20-week abortion ban. States that enacted bans later than 2014 were included in the no ban group. We used Cochrane-Armitage tests to assess trends and multivariable logistic regressions to control for maternal age, race, education, insurance, and ≥ 5 prenatal visits.

Results:

Our cohort consisted of 17,444,271 deliveries in states without a 20-week abortion ban and 8,763,579 deliveries in states with bans. CDH rates did not change over time in both states with and without bans (p=0.3672, p=0.0539) (Figure 1). In states with bans, rates of CCHD increased significantly over time (p=0.0002). In states without bans, the incidence of CCHD decreased significantly (p < 0.0001). When adjusting for confounders, in 2012, states with bans had significantly lower odds of CCHD diagnoses than states without bans (aOR 0.476; 95% CI 0.430-0.527) (Table 1). However, starting in 2016, there was shown to be no change of CCHD diagnoses between both states with and without bans.

Conclusion:

Between 2012-2018, CCHD rates increased significantly in states with 20-week abortion bans and decreased significantly in states without bans. CDH rates did not change significantly in states with or without 20-week abortion bans. Many 20-week abortion bans were enacted near the beginning of the time frame of this study. It’s possible that the differences seen are related to these policies, indicating that such legislation may inhibit patient autonomy.