(277) Impact of restricted access to abortion services on rate of participants with insufficient prenatal care

Objective: Texas Senate Bill 8 (SB8) went into effect 09/21/2021, effectively banning termination procedures with detected embryonic cardiac activity. With the recent US Supreme Court decision in Dobbs v. Jackson Women’s Health, similar restricted access laws are being passed in other states. Our aim was to assess whether rates of insufficient prenatal care (PNC) were of significant difference prior to or post SB8 effect date using a population based-cohort.

Study Design:

This was a retrospective cohort study of a prospectively collected, population-based perinatal database from a large academic center comprised of all deliveries since 2011 in two hospitals in Houston, TX. All pregnancies with complete PNC data were included. The validated Adequacy of Prenatal Care Utilization Index was used, with insufficient PNC defined as PNC begun after the 4th month of gestation or attendance of less than 50% of ACOG-recommended PNVs. PNC data was compared between pregnancies with PNC started prior to or post SB8 effect date (9/21/2021). The primary outcome was insufficient PNC. Logistic regression was used to evaluate the association of receiving PNC after SB8 implementation with insufficient PNC.

Results:

49,272 pregnancies were included. 46.2% of participants with PNC after SB8 had insufficient PNC vs. 22.9% before SB8 (p < 0.001). This trend was consistent with stratification for race or ethnicity (Figure 1). On logistic regression, PNC initiated after SB8 went into effect was independently associated with a higher rate of insufficient PNC (aOR 3.37 95% CI 2.22 – 5.11, Table 1) after adjusting for covariates found to be significant on univariate analysis (maternal age, BMI, and ethnicity). 

Conclusion:

Initiation of PNC after implementation of restrictive termination legislation in Texas was independently associated with an increased rate of insufficient PNC. As sufficient PNC is associated with improved perinatal outcomes, this study provides early evidence that implementation of restricted abortion access laws may have untoward effects on the whole pregnant population, not just those seeking termination.