(305) Effect of Senate Bill 8 on Critical Illness Among Pregnant Versus Non-Pregnant Individuals in Texas

Introduction: On September 1, 2021, Texas Senate Bill 8 (SB8) was enacted, banning abortion after ~6 weeks gestation. Whether SB8 increased maternal critical illness incidence is unknown.

Methods: We conducted a retrospective cohort study of reproductive age (10-54 yrs) patients admitted to Texas hospitals from 2018–2023, comparing pregnant women to non-pregnant women and, separately, men. Pregnancy was defined by previously validated ICD-10 codes. Our primary outcome was critical illness, defined as sepsis or mechanical ventilation (MV) by ICD-10 codes. When there were parallel trends between pregnant patients and controls in the pre-SB8 period, we constructed inverse probability of treatment weighted difference-in-differences (DiD) models. If there were not parallel trends, we constructed similarly weighted comparative interrupted time series (CITS) models. This work was funded by an SCCM research grant.

Results: We included 2,152,797 pregnant women, 1,712,852 non-pregnant women, and 1,455,623 men. Pregnant patients were younger (79.8% 18-34 yrs vs 30.2% [non-pregnant women] and 30.0% [men], p= < 0.001) and had fewer comorbidities. Critical illness was much rarer among pregnant women (0.2%) than in others (non-pregnant women: 10.7%, men: 13.3%, p< 0.001). We found a small relative reduction in critical illness for women admitted while pregnant after SB8 (DiD: -0.39 percentage points (pp) [95% CI: -0.53pp, -0.25pp], p< 0.001). This was driven by a decrease in sepsis (DiD: -0.44pp [-0.58pp, -0.30pp], p< 0.001); MV use did not change (CITS -2.41pp [-6.55pp, 1.73pp], p=0.25). Infection, however, was relatively more common for pregnant patients after SB8 (CITS: 122pp [101pp, 142pp], p< 0.001). Associations were largely similar for pregnant women compared to men.

Conclusions: While we found a small decrease in maternal critical illness after SB8 in Texas, this coincided with a large increase in infection suggesting sepsis—and thus, critical illness—increases may follow. Our study is limited by a short post-policy period and overlap with the COVID-19 pandemic. We intend to further explore disentangling the impacts of COVID and SB8 with these data. Future work should look across more time and outside Texas to fully assess the impact of these restrictions on critical illness incidence.