Division of Maternal-Fetal Medicine and Obstetrics and the Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, and the Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, and the Department of Obstetrics and Gynecology, Stanford University, Stanford, California.
Obstet Gynecol. 2023 Sep 1;142(3):652-659. doi: 10.1097/AOG.0000000000005291. Epub 2023 Aug 3.
To investigate the implications of potential national abortion ban scenarios on the incidence of neonatal single-ventricle cardiac defects.
A decision tree model was developed to predict the incidence of neonatal single-ventricle cardiac defects and related outcomes in the United States under four theoretical national abortion bans: 1) abortion restrictions in existence immediately before the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision, 2) 20 weeks of gestation, 3) 13 weeks of gestation, and 4) a complete abortion ban. The model included incidence of live births of neonates with single-ventricle cardiac defects, neonatal heart surgery (including heart transplant and extracorporeal membrane oxygenation [ECMO]), and neonatal death. Cohort size was based on national pregnancy incidence and different algorithm decision point probabilities were aggregated from the existing literature. Monte Carlo simulations were conducted with 10,000 iterations per model.
In the scenario before the Dobbs decision, an estimated 6,369,000 annual pregnancies in the United States resulted in 1,006 annual cases of single-ventricle cardiac defects. Under a complete abortion ban, the model predicted a 53.7% increase in single-ventricle cardiac defects, or an additional 9 cases per 100,000 live births. This increase would result in an additional 531 neonatal heart surgeries, 16 heart transplants, 77 ECMO utilizations, and 102 neonatal deaths annually. More restrictive gestational age-based bans are predicted to confer increases in cases of neonatal single-ventricle cardiac defects and related adverse outcomes as well.
Universal abortion bans are estimated to increase the incidence of neonatal single-ventricle cardiac defects, associated morbidity, and resource utilization. States considering limiting abortion should consider the implications on the resources required to care for increasing number of children that will be born with significant and complex medical needs, including those with congenital heart disease.
研究潜在的全国堕胎禁令情景对新生儿单心室心脏缺陷发病率的影响。
采用决策树模型预测美国在四种理论性全国堕胎禁令下，新生儿单心室心脏缺陷及相关结局的发生率：1）2022 年 6 月多布斯诉杰克逊妇女健康组织案（Dobbs v Jackson Women's Health Organization）之前的堕胎限制，2）20 周妊娠，3）13 周妊娠，4）完全堕胎禁令。该模型纳入了新生儿单心室心脏缺陷活产、新生儿心脏手术（包括心脏移植和体外膜肺氧合 [ECMO]）和新生儿死亡的发生率。队列规模基于全国妊娠发生率，不同算法决策点的概率从现有文献中汇总。每个模型进行 10000 次蒙特卡罗模拟。
在多布斯裁决之前的情景下，美国每年估计有 636.9 万例妊娠，导致每年有 1006 例单心室心脏缺陷。在完全堕胎禁令下，模型预测单心室心脏缺陷的发病率增加 53.7%，即每 10 万活产增加 9 例。这将导致每年额外增加 531 例新生儿心脏手术、16 例心脏移植、77 例 ECMO 应用和 102 例新生儿死亡。预计更严格的基于妊娠年龄的禁令也将导致新生儿单心室心脏缺陷病例和相关不良结局的增加。
普遍的堕胎禁令估计会增加新生儿单心室心脏缺陷的发病率、相关发病率和资源利用。考虑限制堕胎的州应考虑到这对需要照顾越来越多患有重大和复杂医疗需求的儿童的资源的影响，包括患有先天性心脏病的儿童。
