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Born After Dobbs: Abortion Restrictions And The Rising Burden Of Congenital Heart Disease
Riya Aggarwal, BS1, Kelsey Muir, MD2, Kayley Ross, MPH3, Sahithi Bhavana, MBBS3, Ruchika Kamojjala, BS4, Justin Robinson, MD5, Karl Welke, MD6, Anusha Jegatheeswaran, MD7, Joseph Forbess, MD8, Tara Karamlou, MD9.
1Michigan State University College of Human Medicine, Grand Rapids, MI, USA, 2Warren Alpert Medical School at Brown University, Providence, RI, USA, 3Akron Children's Heart Center, Akron, OH, USA, 4Case Western Reserve University School of Medicine, Cleveland, OH, USA, 5University of Maryland Division of Cardiothoracic Surgery, Baltimore, MD, USA, 6Atrium Health Levine Children's Hospital, Charlotte, NC, USA, 7Great Ormond Street Hospital, London, United Kingdom, 8University of Maryland School of Medicine Children's Heart Program, Baltimore, MD, USA, 9Cincinnati Children's Hospital Medical Center, Akron, OH, USA.
Objective(s): The 2022
Dobbs v. Jackson Women's Health Organization decision created substantial heterogeneity in abortion access across the U.S., with unclear implications for cyanotic congenital heart disease (CCHD) birth trends and associated sociodemographic disparities. We evaluated CCHD birth trends across state-level abortion policy environments and characterized sociodemographic profiles of affected live births.
Methods: Retrospective analysis of CDC Natality Birth Certificate Database (2016-2024, n = 33,589,282) evaluated CCHD temporal trends across U.S. states. States were categorized by abortion policy environment following
Dobbs, with restrictive states implementing prohibitive legislation and protective states preserving or expanding abortion access. Fixed-effects models assessed changes in CCHD incidence by policy environment. Demographic and socioeconomic characteristics of CCHD-affected births were compared across states.
Results: Post-
Dobbs, restrictive states experienced increased CCHD incidence (2.91, 95% CI 1.68-4.13; p < 0.001), whereas protective states were static. Significant state-level increases were observed in Utah (+63.9%; p<0.001), Nebraska (+60.1%), Connecticut (+121.4%), Minnesota (+105.5%), West Virginia (+79.5%), South Carolina (+51.7%), and Colorado (+75.3%). Restrictive states demonstrated decreased Medicaid utilization (42% vs. 38%, p=0.007). Utah exhibited higher maternal bachelor’s degree attainment (35% vs. 42%, p=0.001) and non-Medicaid insurance utilization (74% vs. 83%, p<0.001). Protective states demonstrated an increased proportion of Hispanic mothers (21% vs. 26%, p=0.002).
Conclusions: Following
Dobbs, protective states had stable live-birth CCHD incidence, whereas restrictive abortion policies increased incidence with distinct shifts in sociodemographic trends.
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