by Andrea Suozzo, Sophie Chou and Lizzie Presser

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A first-of-its-kind analysis by ProPublica found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased by more than 50% after Texas’ near-total abortion ban went into effect in September 2021. The analysis also identified at least 120 in-hospital deaths of pregnant or postpartum women in 2022 and 2023 — an increase of dozens of deaths from a comparable period before the COVID-19 pandemic.

Neither the CDC nor states are investigating deaths or severe maternal complications related to abortion bans. And although the federal government and many states track severe complications in birth events using a federally established methodology, far less is known about complications that arise during a pregnancy loss. There is no federal methodology for doing this, so we consulted with experts to craft one.

We acquired Texas hospitalization data from 2017 through 2023, giving us more than two years of data after the implementation of the state’s six-week abortion ban in September 2021, and more than a year of data following its full abortion ban, which went into effect in August 2022.

We spoke with dozens of researchers and clinicians to adapt the federal algorithm for birth complications to focus on severe complications in early pregnancy, before fetal viability.

This methodology lays out the steps we took to complete this analysis, to help experts and interested readers understand our approach and its limitations.

We purchased seven years of inpatient discharge records for all hospitals from the Texas Department of State Health Services. These records contain de-identified data for all hospital stays longer than a day, with information about the stay, including diagnoses recorded and procedures performed during the stay, as well as some patient demographic information and billing data.

Within this dataset, we opted to focus on second-trimester pregnancy loss, because first-trimester miscarriage management often occurs in an outpatient setting. In the future, we plan to look at outpatient data as well.

To examine outcomes in the second trimester, we first identified hospitalizations where a pregnancy ended. We used a methodology to identify severe complications in birth events developed by the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the Alliance for Innovation on Maternal Health, an initiative of the American College of Obstetricians and Gynecologists. The method is outlined in statistical code published by HRSA, and it first identifies every hospitalization with a live birth, stillbirth or an “abortive outcome” (which refers to an intended or unintended pregnancy loss before 20 weeks). Rather than excluding those abortive outcomes to focus on birth, as the HRSA code directs, we included them to look at all hospitalizations where a pregnancy ended. This narrowed our list of hospitalizations to an average of 370,000 per year.

The HRSA methodology further filters hospitalizations to only patients who are female and between the ages of 12 and 54. Our dataset had five-year age ranges, so we filtered to ages between 10 and 54. This brought our hospitalization list to 364,000 each year, on average.

For each hospitalization where a pregnancy ended, we looked for a diagnosis code recording the gestational age of the fetus. In cases where a long hospitalization had multiple gestational week codes recorded over the course of the stay, we took the latest one.

We excluded pregnancy-end hospitalizations without a gestational week code from our analysis — removing about 49,500 hospitalizations, or 1.9% of our dataset. More than two-thirds had coding that indicated a birth, likely to have occurred after 20 weeks.

Based on conversations with doctors and researchers, we narrowed our focus to hospitalizations where a pregnancy ended in the second........

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