In late June, the Supreme Court of the United States (SCOTUS) ruled to overturn the federal right to abortion and allowed state legislatures to decide on this right. The implications of the controversial decision may be life-threatening to some women, as the lack of clarity regarding the legality of the procedure in some states can result in sub-optimal care or hesitation by medical providers, according to the Pew Charitable Trusts. The risk of these ill effects is higher among women who are more likely to suffer from a miscarriage or an ectopic pregnancy, such as those suffering from polycystic ovarian syndrome (PCOS).
Life-threatening conditions associated with miscarriage are not rare, and miscarriage could result in potentially lethal infections. In the case of ectopic pregnancy, when an embryo implants in a fallopian tube instead of the uterus, the growing fetus will cause the area where it grows to burst if left untreated, causing potentially fatal hemorrhaging. Women with PCOS are more likely to experience miscarriage and ectopic pregnancies than those without PCOS.
A large meta-analysis published in the journal Medicine by Yu and colleagues (2016) of approximately 140,000 pregnancies identified that women with PCOS were at nearly three times the risk of miscarriage. Likewise, a study published in the Journal of Clinical Endocrinology and Metabolism by Hart and Doherty used healthcare linkage data of 51,320 women to compare pregnancy outcomes and identified that women with PCOS had approximately double the risk of developing an ectopic pregnancy. Given these increased risks and newfound uncertainty regarding abortion as treatment resulting from the SCOTUS decision, women with PCOS are more likely to suffer from these adverse pregnancy complications now than last month.
Therefore, a consequence of this decision is likely to be an increase in mortality among women with PCOS in states choosing to restrict abortion access. The number of women with PCOS in the US is significant. According to GlobalData, PCOS will impact nearly 4.46 million women of reproductive age in the US in 2022. Even though only approximately half of these women are anticipated to be impacted directly by the SCOTUS decision, the estimated 2.23 million women at a higher risk of maternal mortality can be enough to impact the overall measure of maternal mortality in the US even with exceptions for the health of the mother, as delays in care due to legislative hurdles could increase negative outcomes. Moreover, the number of women with PCOS in the US is anticipated to grow as more women reach reproductive age, suggesting that maternal deaths will likely continue growing, barring intervention.
Therefore, it is imperative for legislators in states restricting abortion access to, at a minimum, issue clear guidance for medical professionals so that they can provide the best evidence-based care. Moreover, it is also critical to educate patients and medical providers about state specific regulations so that they know their rights and are able to act in their best interests.