{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:07:25Z","timestamp":1787026045403,"version":"build-2736575974"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"\n Importance<\/jats:title>\n Spontaneous abortion is the most common complication of early pregnancy and requires the same treatment options as induced abortion. Limited data on the influence of abortion bans on spontaneous abortion management in the United States exist.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the association of state-level abortion bans with spontaneous abortion management and receipt of the evidence-based medication regimen mifepristone plus misoprostol among commercially insured individuals in the United States.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Retrospective cross-sectional study using the Merative MarketScan Commercial Claims database to identify 123\u202f598 individuals aged 15 to 45 years with spontaneous abortion at fewer than 77 days\u2019 gestation from January 1, 2018, through September 30, 2024. A difference-in-differences framework compared management changes from prepolicy (January 2018 to May 2022) to postpolicy (July 2022 to September 2024) in 14 states with trigger bans vs 17 comparison states.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n \n State-level abortion bans restricting abortion to fewer than 6 weeks\u2019 gestation, triggered by the\n Dobbs v Jackson Women\u2019s Health Organization<\/jats:italic>\n decision on June 24, 2022.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Spontaneous abortion management type (expectant, medication, or surgical) and, among individuals receiving medication, receipt of mifepristone plus misoprostol vs misoprostol alone.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study included 123\u202f598 individuals (54\u202f181 in trigger ban states; 69\u202f417 in comparison states) with a mean age of 30.17 years (SD, 6.25 years). In adjusted models, trigger bans were associated with a 2.8 percentage point increase in expectant management (95% CI, 1.0-4.6; baseline to postpolicy change: 26\u202f260 of 35\u202f855 [73.2%] to 14\u202f048 of 18\u202f326 [76.7%] in trigger ban states vs 32\u202f927 of 47\u202f232 [69.7%] to 15\u202f617 of 22\u202f185 [70.4%] in comparison states), a 2.2 percentage point decrease in medication management (95% CI, \u22123.5 to \u22120.9; 3183 of 35\u202f855 [8.9%] to 1446 of 18\u202f326 [7.9%] vs 5054 of 47\u202f232 [10.7%] to 2687 of 22\u202f185 [12.1%]), and no significant change in surgical management. Among individuals receiving medication, trigger bans were associated with a relative 13.8 percentage point increase in misoprostol-only regimens (95% CI, 9.0-18.6; 3124 of 3183 [98.1%] to 1401 of 1446 [96.9%] in trigger ban states vs 4250 of 5054 [84.1%] to 1840 of 2687 [68.5%] in comparison states).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n State-level abortion bans were associated with a shift in spontaneous abortion management away from medication and toward expectant approaches, with persistent reliance on suboptimal misoprostol-only regimens in ban states, suggesting a decrease in management options for individuals with spontaneous abortion in ban states.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.6344","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T15:30:25Z","timestamp":1779118225000},"page":"48","source":"Crossref","is-referenced-by-count":1,"title":["Management of Spontaneous Abortion Among Commercially Insured Individuals in the United States After\n Dobbs v Jackson<\/i>"],"prefix":"10.1001","volume":"336","author":[{"given":"Maria I.","family":"Rodriguez","sequence":"first","affiliation":[{"name":"Center for Reproductive Health Equity, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Fuerst","sequence":"additional","affiliation":[{"name":"Center for Reproductive Health Equity, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Schrote","sequence":"additional","affiliation":[{"name":"Center for Reproductive Health Equity, Department of Obstetrics and Gynecology, Oregon Health & Science University, 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