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Poster Session 2

Category: Health Equity/Community Health

Poster Session 2

(556) A nationwide analysis of adverse delivery outcomes among adolescents pre- and post-Dobbs decision

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Presenting Author(s)

LaMani D. Adkins, MD (she/her/hers)

Resident Physician - Obstetrics and Gynecology
Duke University
Durham, North Carolina, United States

Coauthor(s)

KF

Katie Freedy, BS

Duke University
Duke/Durham, North Carolina, United States
SU

Shakthi Uunithan, MS

Duke University
Duke/Durham, North Carolina, United States
Jonas J. Swartz, MD (he/him/his)

Assistant Professor of Obstetrics & Gynecology
Duke University
Duke/Durham, North Carolina, United States
SD

Sarah K. Dotters-Katz, MD

Associate Professor of Obstetrics and Gynecology
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University
Duke University/Durham, North Carolina, United States
Sarahn M. Wheeler, MD

Associate Professor of Obstetrics and Gynecology
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University
Duke University/Durham, North Carolina, United States

Submitting Author(s)

Rachel L. Wood, MD (she/her/hers)

Assistant Professor of Obstetrics and Gynecology
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University
Durham, North Carolina, United States

Objective:
Adolescents account for 4% of all pregnancies in the United States and approximately 10% of all elective terminations. In June 2022, the Dobbs decision eliminated federal abortion protections and abortion access is adjudicated by state. We evaluated the impact of the Dobbs decision on delivery outcomes in adolescent births based on state level abortion access.

Study Design:
We conducted an IRB approved interrupted time series analysis (ITS) of U.S. adolescent (age < 20 years) births using birth certificate data in two groups of states: those with abortion protection(SAP)- CA, CO, CT, DE, IL, MA, MD, ME, NJ, NV, NY, OR, and VT versus those with trigger bans(TB) restricting abortion access- AR, ID, KY, LA, MS, MO, ND, OK, SD, TN, and UT. Primary outcomes were preterm birth(PTB) (< 37 weeks) and low birthweight(LBW) (< 2500g) across two time periods: pre-Dobbs (January 1, 2021 – May 31, 2022) and post-Dobbs (December 1, 2022 – December 31, 2023). Secondary outcomes included mode of delivery and maternal morbidity.

Results:
142,859 births were included: 78,682 in SAP states and 64,177 in TB states. Overall, average maternal age was 18.1+1.2 years, with most births occurring in white individuals with no meaningful differences in BMI, insurance status, or prenatal care between groups. In both the pre- and post-Dobbs periods, rates of PTB (Figure 1), LBW (Figure 2), cesarean section were significantly higher in TB states; however, there were no changes in the rates within or between groups in the pre- or post-Dobbs period. Maternal morbidity significantly increased above expected in TB states in the post-Dobbs period (RR 1.55, 95% CI 1.11-2.15), there was no significant increase in maternal morbidity in SAP states (RR 1.12, 95% CI 0.85-1.47).

Conclusion:
The rates of preterm birth, low birthweight, and c-section were higher in adolescents in states with abortion trigger bans, though there was no change in these trends following the Dobbs decision. Maternal morbidity for adolescents increased post-Dobbs decision in states with abortion restrictions, aligning with previous findings.