Critical illness outcomes of hospitalized pregnant women following a Texas abortion ban

IMPORTANCE: In September 2021, Texas Senate Bill 8 (SB8) banned abortion after embryonic cardiac activity. OBJECTIVE: To estimate the association of SB8 with critical illness rates. DESIGN: Interrupted time series (ITS). SETTING: Hospitals in Texas. PARTICIPANTS: Retrospective cohort of pregnant women between 10 and 54 years of age hospitalized between January 2018 and March 2024. A subgroup of patients with high-risk features, defined as age 34 years or ≥ 1 chronic illness. MEASUREMENTS: The primary outcome was critical illness, defined as sepsis or mechanical ventilation (MV). Secondary outcomes included sepsis, MV, and infection without organ dysfunction. ITS results are reported as the immediate step change and the sustained slope change (ie, difference in trend line slopes following vs without SB8). RESULTS: In the full cohort (n = 2 344 135), SB8 was not associated with rates of critical illness, sepsis, MV, or infection in adjusted analyses. Following SB8, significantly more hospitalized pregnant patients had high-risk features (slope change per quarter per 1000 hospitalizations: 0.92 [0.08, 1.77]). In the high-risk subgroup (n = 497 144), SB8 was significantly associated with sustained increases in critical illness, sepsis, and infection (slope changes per quarter per 1000 hospitalizations: 0.17 [0.02, 0.33], 0.15 [0.02, 0.28], 1.60 [1.02, 2.17], respectively), but not MV (slope change per quarter per 1000 hospitalizations: 0.05 [-0.03, 0.13]). No significant step changes were observed. CONCLUSION: Following SB8, hospitalized pregnant women with high-risk features experienced significant increases in rates of critical illness, sepsis, and infection. These results may inform infection prevention programs and critical illness training in abortion-restrictive states.