Preliminary Post-Dobbs Trends in Emergency Department Use for Early Pregnancy Complications

TL;DR

This study examines how restrictive abortion laws after the Dobbs decision may affect emergency department visits for early pregnancy complications.

Contribution

The study provides preliminary evidence on ED use trends for early pregnancy complications in regions with restrictive abortion policies.

Findings

No statistically significant increase in ED visits for early pregnancy complications was found post-Dobbs.

Regions with more restrictive abortion policies showed higher adjusted odds of post-Dobbs ED visits, though not statistically significant.

The ED is highlighted as an important setting for managing early pregnancy complications amid reduced access to traditional care.

Abstract

Following the 2022 Dobbs Supreme Court decision, emergency department (ED) use for early pregnancy complications (EPC), such as miscarriage and ectopic pregnancy, may increase in states that enacted severely restrictive abortion policies. Patients may increasingly seek EPC-related care in the ED due to delays in treatment resulting in greater symptom severity or reduced access to usual settings of obstetric and family planning care. Our objective in this study was to examine the association between severely restrictive abortion policies and post-Dobbs EPC-related ED visits.

This retrospective, cross-sectional study used data from the 2016–2022 National Hospital Ambulatory Medical Care Survey. Our primary outcome measure was ED visits among female patients 15–49 years of age for EPC-related care, defined using encounter diagnosis code or chief complaint. We used multivariable logistic regression to examine the association between US region and post-Dobbs, EPC-related visits, as the number of states with severely restrictive abortion policies (bans from conception to six weeks) varied by region, from zero (Northeast) to 10 of 17 states in the South.

We identified 7,872,445 weighted EPC-related visits (unweighted n = 1,008) among 266,222,232 weighted (unweighted n = 32,841) encounters for female patients 15–49 years of age (3.0%). The median age was 28 (IQR 23–32). The proportion of pre- vs post-Dobbs EPC-related visits was 3.1% vs 2.5% in the Northeast (P = .72); 3.2% vs 3.5% in the West (P = .80); 2.4% vs 3.1% in the Midwest (P = .36); and 2.9% vs 3.7% in the South (P = .50). Compared to the Northeast, the adjusted odds of post-Dobbs EPC-related visits were 1.4 in the West (95% CI, 0.4–5.2), 1.4 in the Midwest (95% CI, 0.4–4.6), and 1.3 in the South (95% CI, 0.4–4.7).

This preliminary study did not find a statistically significant association between US region and post-Dobbs ED visits for early pregnancy complications. However, given the increasing restrictions surrounding reproductive healthcare access, the ED represents an important setting for the delivery of this care. Further investigations using more robust data sources are needed to understand the effect of prohibitive abortion laws on the ED use and the management of early obstetric complications.