Trends in Emergency Department Utilization for Early Pregnancy Loss, 2019–2024

The U.S. has seen a significant rise in maternity care deserts, with 35% of counties currently lacking an obstetrician or birthing facility. Further, since the 2022 Dobbs decision, 23 states have enacted abortion restrictions or bans, which may decrease access to reproductive health care beyond pregnancy termination, including care for patients experiencing early pregnancy loss (EPL). Reduced access to routine obstetric care settings may increasingly lead patients to seek EPL care in the Emergency Department (ED). This study aimed to examine trends in settings of care (ED vs. outpatient) for EPL, as well as overall ED utilization related to EPL.

This retrospective cohort study utilized commercial claims data from the IBM MarketScan Research Database. We included patients with an EPL episode of care from 2019 to 2024, identified using relevant ICD-10 codes. Our outcome was the proportion of EPL episodes with at least one ED visit vs. those with only outpatient visits. We also examined the proportion of ED visits for EPL among all ED visits by females aged 15-49. Monthly event rates were modeled using Poisson regression with a log link and an offset for person-time to assess trends over the study period. We report monthly incidence rate ratios (IRR) and 95% confidence intervals (CI).

During the study period, there were 187,575 EPL episodes of care. The median patient age was 32 (IQR 28-36). Overall, 42,813 (22.8%) EPL episodes included at least one ED visit; the remainder had only outpatient visits. The proportion of episodes involving an ED visit increased from 21.2% in 2019 to 26.7% in 2024. The monthly rate of EPL episodes with at least one ED visit rose over the study period (IRR 1.006; CI 1.0055-1.0064, p<.0001). Of the 5,836,147 total ED visits for females aged 15-49, 0.73% were for EPL. The prevalence of EPL-related ED visits increased from 0.66% in 2019 to 0.81% in 2024, corresponding to an IRR of 1.003 (CI 1.0027-1.0035, p<.0001).

This retrospective national claims analysis found a modest increase in the rate of EPL episodes of care involving at least one ED visit; we found a similar trend in the proportion of EPL-related ED visits among females of reproductive age. Future studies should examine these trends among publicly insured patients, who may encounter even greater barriers to accessing reproductive health care, and explore outcomes in states with and without abortion restrictions.