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The Impact of State Legislation on the Incidence of Births with Congenital Anomalies in Texas
*Neha Malik1, *Connor Fritz1, *Clark Andersen1, *Krysta M. Sutyak2, *Eric Bergh2, Nancy D. Perrier1, KuoJen Tsao2, Kevin P. Lally2, *Mary Austin1
1MD Anderson Cancer Center, Houston, TX; 2University of Texas McGovern School of Medicine, Houston, TX

Introduction:
Children born with congenital anomalies often require surgical intervention and pose a significant burden to the healthcare system. In-utero diagnosis allows families to discuss predicted quality of life, and families may make the decision to terminate a pregnancy. Legislation passed in Texas in September 2021 banned abortion after 6 weeks gestation. The aim of this study was to investigate trends in the incidence of births with congenital anomalies after the implementation of state abortion restrictions.
Methods:
A retrospective review of all newborn encounters in the Texas Public Use Inpatient Discharge Database from Q1 2019 to Q3 2023 was performed. Presence of congenital anomalies were identified based upon relevant ICD10 codes. An interrupted time series (ITS) analysis was performed to assess the incidence of congenital anomalies pre and post intervention. Slopes for each time interval were compared to determine if the odds of congenital anomalies changed significantly per period.
Results:
We identified 1,593,239 newborn encounters. 277,826 patients with congenital anomalies were identified, which represented 16.5% of all newborn admissions. Incidence of congenital anomalies increased significantly beginning in Q3 of 2022 and continued to increase through the end of the study period (p=0.003). Our ITS analysis showed that the odds of congenital anomalies increased from 1.063 per year to 1.147 per year after the legislation passage (p<0.0001) (Figure 1). The number of births did not change significantly over the study period. The number of lethal congenital anomalies did not change significantly over the study period and there was no significant evidence of change in mortality after Q2 of 2022. Results were unchanged when controlling for race/ethnicity and insurance. Patients who identified as black (OR: 1.44, p < .0001) or male (OR: 1.23, p< .0001) were more likely to be diagnosed with a congenital anomaly at birth.
Discussion:
With the introduction of strict abortion restrictions in September 2021, the incidence of births with congenital anomalies increased substantially in the state of Texas. Further research is warranted to understand the long-term implications of this increase.
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