The Impact of State Legislation on the Incidence of Births With Congenital Anomalies in Texas

Abstract

Objective: To investigate changes in the incidence of births with congenital anomalies after the passage of abortion restrictions in Texas.

Background summary: In-utero diagnosis of congenital abnormalities allows families to discuss predicted quality of life and costs and potentially decide to terminate a pregnancy. However, in September 2021, Texas Senate Bill 8 (SB8) banned abortion after 6 weeks' gestation with no exceptions for fatal fetal anomalies.

Methods: We retrospectively reviewed all "Newborn" admissions in the Texas Inpatient Public Use Discharge Data File from Q1 of 2019 to Q3 of 2023. Congenital anomalies were identified based on relevant International Classification of Diseases-10 codes. Logistic regression and interrupted time series analysis was performed to assess the incidence of congenital anomalies in relation to SB8. Slopes for each time interval were compared to determine if the odds of congenital anomalies changed significantly per quarter.

Results: We identified 1,686,198 newborn patients. Of these, 277,826 patients (16.5%) had congenital anomalies. The incidence of congenital anomalies increased significantly beginning in Q3 of 2022 through Q3 of 2023 (odds ratio [OR]: 1.05; P=0.002). The per-year odds of congenital anomalies increased from 1.063 before SB8 to 1.147 after SB8 (P<0.0001). The number of lethal congenital anomalies or mortality did not change significantly after Q2 of 2022. Results were unchanged when controlling for race and ethnicity.

Conclusions: With the passage of SB8, the incidence of births with congenital anomalies increased substantially in Texas. Further research is warranted on the long-term implications of this increase.

Keywords: abortion; birth; congenital anomalies; legislation; lethal anomalies; newborn.