Targeted Regulation of Abortion Providers Laws and Pregnancies Conceived Through Fertility Treatment.

Importance: Twenty-seven states have enacted targeted regulation of abortion providers (TRAP) laws that may disproportionately affect higher-risk pregnancies such as those conceived through fertility treatment. Objective: To assess the association of TRAP laws with the relative rates of adverse outcomes of pregnancies conceived through fertility treatment. Design, Setting, and Participants: This cohort study of singleton births conceived through fertility treatment used National Vital Statistics System data on births between 2012 and 2021. Data were analyzed from August 15, 2024, to September 8, 2025. Exposure: Included participants were categorized as either living under the legal jurisdiction of states with or without TRAP laws enacted during the study period. As laws were not passed in every state uniformly, the first year of enforcement was excluded. Main Outcomes and Measures: Demographic characteristics of individuals who conceived with fertility treatments living in states with and without TRAP laws were compared using χ2 and analysis of variance tests. A maternal composite of adverse outcomes was constructed. Secondary outcomes included a neonatal composite of adverse outcomes and rate of preterm birth. Controlling for potential confounders, generalized estimating equation models with binomial distribution, identity link, and robust sandwich SE estimators were used to assess adjusted absolute percentage point differences comparing states with and without TRAP laws across the enactment of TRAP laws. Results: This study included 416 019 singleton births (mean [SD] maternal age, 34.5 [5.3] years; mean [SD] gestational age, 38.3 [2.4] weeks; 213 294 males [51.3%]) conceived with fertility treatment. Of these births, 174 671 (42.0%) occurred in states with TRAP laws and 241 348 (58.0%) in states without these laws. Generalized estimating equation models demonstrated a greater increase in the composite of adverse maternal outcomes (absolute adjusted difference-in-differences, 0.25; 95% CI, 0.003-0.50) in states with TRAP laws relative to states without. Conclusions and Relevance: These findings suggest an increase in maternal morbidity among patients using fertility care in states that passed TRAP laws relative to states that did not.