Pregnancy Termination Policy and Cleft Lip and Palate

Restrictive policies on termination of pregnancy (TOP) may lead to more infants with congenital abnormalities. This study aimed to assess the association between statewide enactment of TOP restriction and cleft lip and/or palate (CL/P) incidence, and to identify mediating demographic characteristics.

The authors examined state-specific trends in CL/P incidence in infants before and after implementation of laws restricting TOP in Michigan compared with New York, where no such laws were passed. The percentage change of CL/P incidence per 1000 live births in postpolicy years (2012 to 2015) compared with prepolicy years (2005 to 2011) was compared, with adjustments for confounding factors in multivariate models.

The incidence of CL/P changed significantly in Michigan (19.1%) compared with New York (-7.31%). Adjusting for sex, race/ethnicity, median household income level, and expected payer, the adjusted percentage difference between Michigan and New York was 53.3% ( P < 0.001). Stratification by race/ethnicity and median household income demonstrated that changes were only significant among Black (139%; P < 0.001) and Hispanic (125%; P = 0.045) patients and among those from the lowest (50.3%; P < 0.001) and second lowest (40.1%; P = 0.01) income quartiles.

The authors' research, combined with the recent Supreme Court decision in Dobbs v Jackson Women's Health Organization allowing states to place further restrictions on TOP, suggests that more infants in the future will be born in need of treatment for CL/P.