P1.160: The Impact of Abortion Bans on Neonatal Intensive Care Utilization (NICU) Utilization

Background: State level abortion policies changed dramatically following the US Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization in June 2022. Several states immediately imposed complete or 6-week abortion bans. Studies show subsequent rises in fertility rates (births per 1000 reproductive-aged females), infant mortality rates, and congenital anomaly incidence in states with restrictive abortion policies. Research on the impact of such policies on NICU demand is limited.

Methods: A retrospective cohort study of births from 2019-2024 was conducted using data from the Vizient® Clinical Data Base. 14 states which implemented a total or 6-week abortion ban were compared against the remaining states plus DC as states with bans vs. without bans. 2019-2022 births were considered ‘pre-ban’ and 2023-2024 births as ‘under ban’ among both state groups, consistent with previously published methodology. In-hospital outcomes assessed included the portion of births admitted to the ICU; and among births with ICU utilization, ICU length of stay (LOS), total LOS and mortality. Chi-square and t-tests were used to assess statistical significance.

Results: From 2019 to 2024, a total of 6,205,325 births were analyzed (28% of US births), including 1,302,984 (22%) births in abortion ban states and 4,902,341 (31%) births in states without bans (Table 1). 129 hospitals (20% of these were academic medical centers (AMC)) from ban states and 469 hospitals (25% AMC) from non-ban states were included in the analysis. States with a ban had statistically significantly higher ICU utilization percentages, compared to states without bans (11.9% vs. 8.6%; p< 0.001). In states with bans, the mean ICU LOS significantly increased from 13.7 days (SD = 25.7) pre-ban to 14.5 days (SD = 26.9) under the ban (p < .0001). Similarly, the mean total LOS rose from 19.0 days (SD = 29.9) to 19.6 days (SD = 31.4) (p < .0001). In contrast, states without abortion bans showed no statistically significant change in ICU LOS (14.4 to 14.7 days, p = 0.06), and decreased in total LOS from 19.2 to 18.8 days (p < .05). In-hospital mortality declined slightly in ban states (2.25% to 2.17%) and increased in states without a ban (1.93% v 2.02%; p < 0.05) (Table 2).

Conclusion: States that imposed a complete or 6-week abortion ban had an increase in NICU LOS and total LOS among neonates in subsequent years. This increase was not found in states without abortion bans, where instead, LOS decreased. In-hospital mortality did not increase in ban states despite rising NICU demand, which will challenge bed and workforce capacity and indicate rising acuity. One limitation of this analysis is the sample, which is limited to hospitals reporting to the Vizient® Clinical Data Base.