In a recent statement published in Pregnancy, the Society for Maternal-Fetal Medicine (SMFM) emphasized individualized care for high-risk pregnancies, including those affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT), and recommended that patients be counseled about all medically appropriate pregnancy management options.
The guidance stated risk can change during pregnancy, and decisions should incorporate the patient’s preferences through shared decision-making.
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FNAIT occurs when maternal antibodies target fetal platelet proteins, potentially causing severe fetal or newborn thrombocytopeniaThrombocytopenia A platelet count that is lower than normal. and, in serious cases, bleeding in the brain. Because fetal conditions can alter the risks associated with pregnancy, patients with FNAIT or other complex fetal diagnoses may require specialized maternal-fetal medicine care. More broadly, the SMFM statement identifies fetal conditions, maternal diseases and multifetal pregnancies as circumstances that can increase pregnancy-related risks.
The statement warns that restrictions on abortion can complicate medical decision-making when continuing a pregnancy may increase risks to the pregnant patient.
“Legal restrictions on abortion care in many states make it challenging or impossible for clinicians to practice standard-of-care, evidence-based medicine and for institutions to implement evidence-based clinical guidelines for reproductive healthcare,” the group stated.
In one Texas case series involving previable or periviable preterm premature rupture of membranes, 57% of patients experienced significant maternal morbidity after state-mandated expectant management, compared with 33% in published cohorts from states without similar restrictions. Of 28 patients, 27 (96%) experienced stillbirth or neonatal death.
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A separate Texas study involving severe, life-limiting fetal anomalies found that maternal morbidity increased from 35% before abortion restrictions to 72% afterward. All pregnancies managed expectantly ended in stillbirth or infant death.
The SMFM wrote that “each pregnancy is unique” and requires individualized decisions between patients and clinicians.
For patients, the guidance means that counseling should address how risks may change over time rather than treating an early pregnancy risk assessment as permanent. When a fetal condition such as FNAIT or a fetal anomaly is diagnosed, clinicians should provide understandable information about prognosis, treatment and pregnancy continuation as well as abortion when it is legally available. Earlier prenatal screening and diagnosis may also give patients more time to consider their options.
The statement also warns that abortion restrictions can affect future access to high-risk pregnancy specialists. At least 40% of obstetrics and gynecology residents are expected to have limited experience with abortion care, potentially contributing to shortages of clinicians trained to manage complex pregnancies. SMFM recommends institutional collaboration, referral networks and broader training so patients can continue receiving specialized care when complications arise.
