ImportancePrior observational research has shown that infants born in states with more abortion restrictions are more likely to die during infancy. It is unclear how recent and more severe abortion bans in the US have impacted infant mortality.ObjectiveTo examine whether Texas Senate Bill 8 (SB8), which banned abortions after embryonic cardiac activity and did not allow exemptions for congenital anomalies, is associated with infant mortality in the state of Texas.Design, Setting, and ParticipantsThis population-based cohort study of all recorded infant deaths from the state of Texas and 28 comparison states used a comparative interrupted time series analysis with an augmented synthetic control approach and national birth certificate data from January 1, 2018, to December 31, 2022, to estimate the difference between the number of observed and expected infant and neonatal deaths and death rates among monthly cohorts exposed to Texas’ SB8.ExposureDeaths in March 2022 were treated as the first cohort exposed to the Texas’ SB8 abortion policy because these infants (if born full term) were approximately 10 to 14 weeks’ gestation when SB8 went into effect on September 1, 2021. The exposure period was thus March through December 2022.Main Outcomes and MeasuresOur outcomes were monthly counts and rates of infant (aged <1 year) and neonatal (aged <28 days) deaths in the exposure period in Texas. In secondary analyses, annual changes in cause-specific infant deaths between 2021 and 2022 in Texas and the rest of the US were examined.ResultsBetween 2018 and 2022, there were 102 391 infant deaths in the US, with 10 351 of these deaths occurring in the state of Texas. Between 2021 and 2022, infant deaths in Texas increased from 1985 to 2240, or 255 additional deaths. This corresponds to a 12.9% increase, whereas the rest of the US experienced a comparatively lower 1.8% increase. On the basis of the counterfactual analysis that used data from Texas and eligible comparison states, an excess of 216 infant deaths (95% CI, −122 to 554) was observed from March to December 2022, or a 12.7% increase above expectation. At the monthly level, significantly greater-than-expected counts were observed for 4 months between March and December 2022: April, July, September, and October. An analysis of neonatal deaths found somewhat similar patterns, with significantly greater-than-expected neonatal deaths in April and October 2022. Descriptive statistics by cause of death showed that infant deaths attributable to congenital anomalies in 2022 increased more for Texas (22.9% increase) but not the rest of the US (3.1% decrease).Conclusions and RelevanceThis study found that Texas’ 2021 ban on abortion in early pregnancy was associated with unexpected increases in infant and neonatal deaths in Texas between 2021 and 2022. Congenital anomalies, which are the leading cause of infant death, also increased in Texas but not the rest of the US. Although replication and further analyses are needed to understand the mechanisms behind these findings, the results suggest that restrictive abortion policies may have important unintended consequences in terms of trauma to families and medical cost as a result of increases in infant mortality. These findings are particularly relevant given the recent Dobbs v Jackson Women’s Health Organization US Supreme Court decision and subsequent rollbacks of reproductive rights in many US states.

中文翻译：

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德克萨斯州 2021 年禁止妊娠早期堕胎后婴儿死亡


重要性先前的观察研究表明，在堕胎限制较多的州出生的婴儿更有可能在婴儿期死亡。目前尚不清楚美国最近更严格的堕胎禁令对婴儿死亡率有何影响。目的研究德克萨斯州参议院第 8 号法案 (SB8) 是否与婴儿死亡率相关，该法案禁止胚胎心脏活动后堕胎，并且不允许先天性异常情况豁免设计、设置和参与者这项基于人群的队列研究对德克萨斯州和 28 个比较州的所有记录的婴儿死亡进行了比较，使用了增强综合控制方法和国家出生证明数据的比较中断时间序列分析。 2018年1月1日至2022年12月31日，估计暴露于德克萨斯州SB8的每月队列中观察到的和预期的婴儿和新生儿死亡人数以及死亡率之间的差异。暴露于2022年3月的死亡被视为第一批暴露于德克萨斯州的 SB8 堕胎政策，因为当 SB8 于 2021 年 9 月 1 日生效时，这些婴儿（如果足月出生）大约怀孕 10 至 14 周。因此，暴露期为 2022 年 3 月至 2022 年 12 月。主要成果和措施我们的成果是德克萨斯州暴露期间婴儿（<1 岁）和新生儿（<28 天）死亡的每月计数和比率。在二次分析中，对 2021 年至 2022 年德克萨斯州和美国其他地区特定原因婴儿死亡的年度变化进行了检查。结果 2018 年至 2022 年，美国有 102 391 名婴儿死亡，其中 10 351 名死亡发生在德克萨斯州。 2021 年至 2022 年间，德克萨斯州的婴儿死亡人数从 1985 年增加到 2240 人，即新增 255 人死亡。 这相当于 12.9% 的增长，而美国其他地区的增长相对较低，为 1.8%。根据使用德克萨斯州和符合条件的比较州的数据进行的反事实分析，从 2022 年 3 月到 12 月，观察到超过 216 例婴儿死亡（95% CI，-122 至 554），比预期增加了 12.7%。从月度来看，2022 年 3 月至 12 月之间的 4 个月（即 4 月、7 月、9 月和 10 月）观察到的计数明显高于预期。对新生儿死亡的分析发现了一些相似的模式，2022 年 4 月和 10 月的新生儿死亡明显高于预期。按死因分类的描述性统计数据显示，2022 年德克萨斯州因先天性异常导致的婴儿死亡增加更多（增加 22.9%）但美国其他地区则不然（下降了 3.1%）。结论和相关性这项研究发现，德克萨斯州 2021 年禁止怀孕早期堕胎与 2021 年至 2022 年期间德克萨斯州婴儿和新生儿死亡率意外增加有关。婴儿死亡的主要原因，在德克萨斯州也有所增加，但美国其他地区则没有增加。尽管需要重复和进一步分析来了解这些发现背后的机制，但结果表明，限制性堕胎政策可能会因婴儿死亡率增加而对家庭造成创伤和造成医疗费用产生严重的意想不到的后果。鉴于最近的情况，这些发现尤其相关多布斯诉杰克逊妇女健康组织美国最高法院的裁决以及随后美国许多州的生育权被撤销。