Impacts of Dobbs Decision and COVID-19 on Abortion-related Trends within TriNetX Electronic Medical Record Data

Background: Recent events including COVID-19 (beginning March 2020) and the Dobbs decision (24Jun2022) have impacted reproductive trends within the US. With the Dobbs, the US Supreme Court overturned Roe v. Wade (1973) and Planned Parenthood v. Casey (1992) and determined that the US Constitution did not protect the right to abortion returning abortion regulation to the states, where some have increased restrictions or made it illegal. It is important to examine abortion trends pre COVID-19 and before and after this ruling to understand potential impacts.

Objectives: To describe spontaneous abortion (SAB) and induced abortion (IAB) trends, including those associated with medication use, pre COVID-19 and before and after the Dobbs decision using electronic medical records (EMR) data within the TriNetX network, a live EMR database of >50M patients.

Methods: US female patients reporting one of 16 SAB or 19 IAB ICD-10, healthcare common procedure, diagnosis, or medication codes (including two mifepristone-specific) were analyzed into the SAB or IAB cohort, respectively. Timing was categorized into 18-month periods: “pre-COVID” (25Jun2018-25Dec2019), “pre-Dobbs” (25Dec2020 24Jun2022), and “post-Dobbs” (25Jun2022-25Dec2023).

Results: For SAB, there were 240,930 abortion event codes among 140,850 patients pre-COVID, 239,380/139,010 pre-Dobbs, and 206,120/121,240 post-Dobbs. For IAB, there were 36,350 (17% medication-related) abortion event codes among 21,600 patients pre-COVID, 44,930 (26% medication-related)/26,150 pre-Dobbs, and 43,450 (30% medication-related)/25,540 post-Dobbs. The mean age of patients in both cohorts ranged from 31-35, the majority of patients were white and not Hispanic or Latino.

Conclusions: While SAB event codes pre-COVID and pre-Dobbs are similar, there is a decrease in codes associated with SAB event codes recorded in the 18-months after the Dobbs decision compared to the 18-month period before the ruling. In contrast, IAB event codes increased from pre-COVID to pre-Dobbs and then stayed consistent post-Dobbs. Trends in medication codes increased from pre-COVID to pre-Dobbs and then increased again post-Dobbs. Despite the known limitations of EMR data in completeness of IAB data, these results are consistent with national CDC abortion surveillance. Continued monitoring of pregnancy occurrence and abortion trends is needed to determine potential impacts of the Dobbs decision and COVID-19 on pregnancy outcomes studies.