The incidence of babies born with serious heart defects, known as cyanotic congenital heart disease (CCHD), rose in states that enacted restrictive abortion laws following the U.S. Supreme Court's 2022 ruling that put abortion laws in the hands of the states, according to a study being presented at the American College of Cardiology's Annual Scientific Session (ACC.25).
The study is the first to look at rates of congenital heart defects since the Dobbs v. Jackson Women's Health Organization ruling, also known as the Dobbs decision, which overturned the federal right to abortion and led to varying access to abortion across states. Researchers found that the incidence of CCHD held steady in states with laws protecting abortion access and rose in states with more restrictive abortion laws, exceeding model estimates of what the rates would have been without Dobbs.
"If the trend toward an increasing number of CCHD births is true, then there will be a larger population of patients with complex congenital heart disease that will need [early and lifelong] health care," said Stephanie Tseng, MD, assistant professor and pediatric cardiologist at Nationwide Children's Hospital in Columbus, Ohio, and the study's lead author. "The health care system, particularly in states with restrictive policies, will need to prepare for these patients, as we know that CCHD patients have higher health care utilization needs. This includes health care costs, resources and [an increased] need for health care workers. There will be non-financial physical and emotional strains on families, as well."
However, Tseng said that the study only shows potential associations and is not designed to identify the causes of the trends that were observed. Other factors besides abortion access could explain the differences between states, such as potential differences in prenatal care and timing of CCHD diagnosis, or differences in maternal risk factors such as diabetes that could affect the likelihood of having a baby with CCHD.
CCHD encompasses several types of heart defects that reduce the delivery of oxygen to the body. Most babies born with these conditions require intervention during the neonatal period to survive. In the current era, up to 15% to 20% of babies with CCHD die in their first year and many of those who survive require lifelong cardiology care to keep their heart working properly. This includes regular cardiology visits, testing and a potential need for additional procedures or surgeries in the future.
CCHD can typically be diagnosed on ultrasound scans performed during the second trimester of a pregnancy, although sometimes the condition is not diagnosed until after birth. The causes are usually unknown, but it is thought that genetics and environmental factors can both play a role.
For the study, researchers used birth certificate data from the U.S. Centers for Disease Control and Prevention to analyze the rates of CCHD among babies born between 2016-2024 in 20 states that enacted restrictive abortion laws and nine states with the most protective abortion policies following Dobbs.
Comparing the birth rates of babies with CCHD over time, the researchers found that rates in states with more restrictive abortion policies diverged from those in states with more protective policies in the two years following the Dobbs decision. The median monthly overage comparing expected to observed differences was 9.6 per 100,000 births.
Another analysis quantified the degree of difference in the observed CCHD incidence over time versus the incidence that would be expected based on pre-Dobbs trends. The results showed a moderate degree of difference between observed and forecasted incidence, with most of the months post-Dobbs exceeding the average predicted incidence.
Based on the timing of when CCHD can be diagnosed prenatally and the new abortion laws, researchers said it may be plausible that the increase stems from babies being born to families who might have chosen to terminate the pregnancy if abortion were an option in their state.
"We've come a long way in caring for these individuals, but the mortality rate can still be high," Tseng said. "Some of these defects can be quite severe and may not have good surgical options, and some families may consider pregnancy termination based on the outlook for the baby and the family."
Regardless of what is driving the apparent trends, Tseng said that the study can help health care systems anticipate health care needs, as more babies being born with CCHD means that more children will require continuing care for these conditions as they grow up. Moving forward, she said it would be helpful to continue to track these trends to inform the allocation of health care resources.
Due to limitations in the data, Tseng said it is not possible to determine the specific CCHD diagnosis in each case, to know whether the condition was diagnosed before birth, or to track the exact impacts that local policies may have had. Despite these limitations, the researchers said that the findings are notable trends that warrant further long-term evaluation.
