ProPublica conducted a groundbreaking analysis revealing a more than 50% increase in sepsis rates during second-trimester pregnancy loss hospitalizations following Texas’ near-total abortion ban in September 2021. The research also reported at least 120 in-hospital deaths of pregnant or postpartum women in 2022 and 2023, highlighting an increase from similar periods before the COVID-19 pandemic. Neither the CDC nor state authorities are investigating deaths or severe maternal complications linked to abortion bans, although severe birth event complications are tracked using a federal methodology. Limited information exists on complications during pregnancy loss, prompting ProPublica to collaborate with experts to develop a new methodology.
The analysis utilized Texas hospitalization data from 2017 to 2023, covering periods post-implementation of the state’s six-week abortion ban in September 2021 and the full abortion ban starting August 2022. Researchers adapted the federal algorithm for birth complications to focus on early pregnancy complications before fetal viability. The study details the steps taken for the analysis, offering transparency into the approach and its constraints.
ProPublica acquired inpatient discharge records from the Texas Department of State Health Services spanning seven years. These records, de-identified, contained detailed information about hospital stays exceeding a day, including diagnoses and procedures. The study concentrated on second-trimester pregnancy loss, distinguishing it from first-trimester miscarriage usually managed in outpatient settings. Plans are in place to examine outpatient data in future analyses.
To study second-trimester outcomes, the team identified hospitalizations where pregnancies ended, using a methodology developed by agencies like HRSA and the CDC. This methodology identifies hospitalizations with live births, stillbirths, or abortive outcomes. ProPublica included abortive outcomes to focus on all pregnancy-ending hospitalizations, resulting in an average of 370,000 annual hospitalizations.
Applying further HRSA methodology, the dataset was refined to female patients aged 12 to 54, narrowing the list to 364,000 hospitalizations annually. Researchers sought diagnostic codes indicating fetal gestational age in each case and excluded cases without this code, refining the dataset to 15,188 second-trimester hospitalizations from 13 to 21 weeks and six days gestation.
The analysis found no significant changes in the race, ethnicity, or insurance coverage of hospitalized patients after Texas’ 2021 abortion ban, known as SB 8. It reported a stable number of second-trimester hospitalizations and stable patient demographics from 2017 to 2023, with a drop to 2,036 hospitalizations in 2023 compared to the yearly average of 2,169.
Investigating sepsis rates, researchers identified life-threatening sepsis indicators that may follow delayed uterine evacuation. They added five sepsis codes specific to early pregnancy complications to the CDC’s list to thoroughly capture early pregnancy complications. Comparing data from nine quarters before SB 8 with nine quarters after its enactment, the analysis revealed a 55% increase in sepsis rates from 2.9% to 4.5%.
The study examined the likelihood of sepsis in cases where a fetal heartbeat was present at admission, discovering higher rates among these cases. This led to a significant increase in sepsis rates post-SB 8, a finding validated through statistical tests. The analysis acknowledged limitations, such as changes in coding practices over time, the inability to account for outpatient care, and missing hospital records, cautioning that figures might not fully represent changes in health care practices or patient outcomes.
ProPublica’s findings add to evidence suggesting that Texas’ abortion ban may be causing dangerous delays in care. Maternal health experts consulted supported this interpretation, proposing that the ban explains the jump in sepsis cases. The analysis also identified 120 women who died while hospitalized during pregnancy or shortly after childbirth in 2022 and 2023, amid criticisms of the Texas Maternal Mortality and Morbidity Review Committee’s decision to skip reviewing these deaths until 2024.
Comparing Texas’ maternal mortality rates to national figures using CDC data, ProPublica noted a 33% increase in Texas from 2019 to 2023, against a national decrease of 7.5%. The study observed an increase in deaths during the COVID-19 pandemic, with 60% of the 2021 deaths related to COVID-19. ProPublica highlighted its findings in the context of the federal methodology it adapted, noting revisions to the method’s source materials and underscoring the importance of its investigation amid limited transparency from state health officials.
