Abstract Importance In September 2021, Texas Senate Bill 8 (SB8) banned abortion after embryonic cardiac activity. Objective To estimate the association of SB8 with critical illness rates. Design Interrupted time series (ITS). Setting Hospitals in Texas. Participants Retrospective cohort of pregnant women between 10-54 years of age hospitalized between January 2018—March 2024. A subgroup of patients with high-risk features, defined as age 18 or 34 years or ≥ 1 chronic illnesses. Measurements The primary outcome was critical illness, defined as sepsis or mechanical ventilation (MV). Secondary outcomes included sepsis, MV, and infection without organ dysfunction. ITS results are reported as the immediate step change and the sustained slope change (ie, difference in trend line slopes following versus without SB8). Results In the full cohort (n = 2,344,135), SB8 was not associated with rates of critical illness, sepsis, MV, or infection in adjusted analyses. Following SB8, significantly more hospitalized pregnant patients had high-risk features (slope change per quarter per 1,000 hospitalizations: 0.92 0.08, 1.77). In the high-risk subgroup (n = 497,144), SB8 was significantly associated with sustained increases in critical illness, sepsis, and infection (slope changes per quarter per 1,000 hospitalizations: 0.17 0.02, 0.33, 0.15 0.02, 0.28, 1.60 1.02, 2.17, respectively), but not MV (slope change per quarter per 1,000 hospitalizations: 0.05 -0.03, 0.13). No significant step changes were observed. Conclusion Following SB8, hospitalized pregnant women with high-risk features experienced significant increases in rates of critical illness, sepsis, and infection. These results may inform infection prevention programs and critical illness training in abortion-restrictive states.
Chen et al. (Sat,) studied this question.