Shortly after her party switch, Cotham cast the deciding vote for legislation to restrict abortion access in North Carolina.

[citation needed] Cotham is a "former CMS Teacher of the Year and assistant principal of East Mecklenburg and Independence high schools".

[2] In 2015, Cotham gave a speech on the House floor explaining that she had had an abortion, saying, "This decision was up to me, my husband, my doctor and my God.

[5] Cotham filed to run for the U.S. House seat on March 21, 2016, but lost the Democratic primary to incumbent Congresswoman Alma Adams.

She worked as a registered lobbyist, routinely engaging with the leadership in the North Carolina General Assembly.

[11] In early 2023, Cotham voted to codify the abortion-related Roe v. Wade decision into state law.

Cotham's move gave House Republicans a veto-proof majority that allowed them to pass legislation without negotiating with North Carolina's Democratic governor, Roy Cooper.

[22] Tricia Cotham was married to state Democratic Party chair Jerry Meek in late 2008.