Implications of abortion legislation on birth defect surveillance

IF 1.6 4区医学 Q4 DEVELOPMENTAL BIOLOGY Birth Defects Research Pub Date : 2024-01-31 DOI:10.1002/bdr2.2302

Amanda L. Elmore, Dominique Heinke, Jean Paul Tanner, Russell S. Kirby, Sarah G. Obican, Jason L. Salemi

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Abstract

Background

Surveillance of birth defects is critical to track prevalence and inform prevention efforts. Previous studies suggest that restricting abortion may lead to an increase in birth defect prevalence. However, it is unclear how abortion legislation will impact birth defect prevalence estimates reported by state-based surveillance programs.

Methods

We described current abortion legislation and surveillance program methodology, by state, as a foundation for understanding the program-level impact on surveillance. We estimated the quantitative effect of abortion legislation on birth defect prevalence for various scenarios using first-order Monte Carlo simulation. Finally, we discuss the implications for interpreting birth defect prevalence estimates following abortion legislation.

Results

Among states that restrict abortion ≤18 weeks and have a surveillance program (N = 19), eight programs (42%) capture elective terminations (<20 weeks) and 17 (89%) include fetal deaths (≥20 weeks) in their estimates. Abortion bans increased the prevalence of any birth defect by 16.6%, 15.8%, and 8.7% for systems with live births only, all outcomes ≥20-weeks, and all outcomes ≥10-weeks, respectively. We found the largest change in prevalence for anencephaly with an estimated 32.5% increase among systems with live births only.

Conclusions

Abortion legislation is likely to further exacerbate the difficulties of multi-state birth defect research and surveillance, while also hindering analysis of intra-state prevalence trends. Birth defect surveillance systems in states with abortion bans may wish to consider monitoring and reporting changes in pregnancy outcomes and infant survival, in addition to birth defect prevalence, to inform public health and health care service needs.

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堕胎立法对出生缺陷监测的影响

背景出生缺陷监测对于追踪出生缺陷的流行情况并为预防工作提供信息至关重要。以往的研究表明，限制堕胎可能会导致出生缺陷发生率上升。然而，目前尚不清楚堕胎立法将如何影响各州监测计划报告的出生缺陷患病率估计值。方法我们按州描述了当前的堕胎立法和监测计划方法，为了解计划层面对监测的影响奠定了基础。我们使用一阶蒙特卡罗模拟估算了堕胎立法在各种情况下对出生缺陷流行率的定量影响。最后，我们讨论了堕胎立法对出生缺陷发生率估计值的解释意义。结果在限制堕胎≤18 周且有监测计划的州（N = 19）中，有 8 个州（42%）将选择性终止妊娠（20 周）和 17 个州（89%）将胎儿死亡（≥20 周）纳入其估计值中。在仅有活产、所有结果≥20 周和所有结果≥10 周的系统中，堕胎禁令使任何出生缺陷的发生率分别增加了 16.6%、15.8% 和 8.7%。我们发现无脑畸形的发病率变化最大，在仅有活产的系统中估计增加了 32.5%。结论堕胎立法可能会进一步加剧多州出生缺陷研究和监测的困难，同时也会阻碍对州内患病率趋势的分析。禁止堕胎的各州的出生缺陷监测系统不妨考虑除监测和报告出生缺陷患病率外，还监测和报告妊娠结局和婴儿存活率的变化，以便为公共卫生和医疗保健服务需求提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Birth Defects Research Medicine-Embryology

CiteScore

3.60

自引率

9.50%

发文量

153

期刊介绍： The journal Birth Defects Research publishes original research and reviews in areas related to the etiology of adverse developmental and reproductive outcome. In particular the journal is devoted to the publication of original scientific research that contributes to the understanding of the biology of embryonic development and the prenatal causative factors and mechanisms leading to adverse pregnancy outcomes, namely structural and functional birth defects, pregnancy loss, postnatal functional defects in the human population, and to the identification of prenatal factors and biological mechanisms that reduce these risks. Adverse reproductive and developmental outcomes may have genetic, environmental, nutritional or epigenetic causes. Accordingly, the journal Birth Defects Research takes an integrated, multidisciplinary approach in its organization and publication strategy. The journal Birth Defects Research contains separate sections for clinical and molecular teratology, developmental and reproductive toxicology, and reviews in developmental biology to acknowledge and accommodate the integrative nature of research in this field. Each section has a dedicated editor who is a leader in his/her field and who has full editorial authority in his/her area.