When abortion access is limited: New SMFM guidance for high-risk pregnancies

Clinical takeaway: For patients at elevated risk of pregnancy-related complications, provide accurate, evidence-based counseling on maternal and fetal risks, discuss all legally available management options including abortion care, and establish referral pathways early when access may be limited.

Abortion care and counseling are a core part of managing high-risk pregnancies and cannot be separated from maternal-fetal medicine practice, according to a new special statement from the Society for Maternal-Fetal Medicine (SMFM). The guidance focuses on how clinicians and institutions can maintain evidence-based reproductive healthcare in states where abortion access is restricted.

Rather than offering disease-specific recommendations, the statement outlines practical strategies to improve patient care, reduce delays, and minimize uncertainty created by varying state laws. SMFM encourages maternal-fetal medicine specialists to take leadership roles in developing institutional policies and regional collaborations that support timely reproductive healthcare.

Key recommendations include providing all patients at increased risk of pregnancy-related morbidity with accurate information about maternal risks, prognosis, treatment options, and the availability of abortion care. The statement emphasizes shared decision-making that incorporates patient values and preferences, recognizing that risks and goals may change as pregnancy progresses.

SMFM also recommends that patients receiving a prenatal diagnosis of a fetal anomaly be offered unbiased, evidence-based counseling and informed of all management options, including abortion care. The group further supports efforts to expand access to early prenatal screening, genetic testing, and first-trimester anatomy ultrasound to facilitate earlier diagnosis and decision-making.

To improve access to care, the statement urges institutions to create multidisciplinary advisory groups, develop rapid-response processes for legally complex cases, establish referral and transfer networks with out-of-state abortion providers, and provide resources that help patients obtain financial and logistical support for travel when necessary.

The document also addresses care after self-managed abortion, advising clinicians to focus on necessary medical management while minimizing documentation that could expose patients to legal risk. In most cases, management is similar to that for spontaneous pregnancy loss, according to the authors.

Training is another major focus. SMFM states that comprehensive pregnancy-options counseling, including abortion counseling, should be considered a core competency in maternal-fetal medicine fellowship training, warning that abortion restrictions may worsen workforce shortages and contribute to clinician moral distress.

“As high-risk pregnancy physicians, we know first-hand that restrictions on abortion care hinder our ability to provide compassionate, evidence-based healthcare for our patients,” said lead author Justin R. Lappen, MD. “This new guidance helps MFMs use their expertise, experience, and leadership to build reliable and collaborative systems so that pregnant patients receive the very best care without unnecessary delay.”

Source: (2026 Sep 15) Pregnancy. Society for Maternal-Fetal Medicine Special Statement: Considerations for management of high-risk pregnancies when abortion care is restricted, published in Pregnancy