Primary Submission Category: LGBTQ+
Sexual orientation disparities in pregnancy-related morbidities
Authors: Payal Chakraborty Bethany Everett Tabor Hoatson Jennifer J. Stuart Colleen A. Reynolds Sarah McKetta Kodiak K.R.S. Soled Aimee K. Huang Jorge E. Chavarro A. Heather Eliassen Juno Obedin-Maliver S. Bryn Austin Janet Rich-Edwards Sebastien Haneuse Brittany M. Charlton
Presenting Author: Payal Chakraborty*
Background: Sexual minority women (SMW; e.g. those with same-sex/gender attractions/partners or who identify as lesbian/gay/bisexual) experience structural inequities that result in adverse obstetrical and perinatal health. Yet, little is known about disparities in pregnancy morbidities among SMW.
Methods: We used data from the Nurses’ Health Study II—a cohort of nurses across the US—restricted to those with pregnancies ≥20 weeks gestation (70,781 women; 162,403 pregnancies). Our primary outcomes were gestational diabetes (GD), gestational hypertension (gHTN), and pre-eclampsia (PRE-E), which participants reported for each of their pregnancies. Participants also reported their sexual orientation identity and same-sex attractions/partners. We compared the odds (age-adjusted) of each outcome in pregnancies among completely heterosexual women (reference) to those among the following groups: (1) heterosexual, had past same-sex attractions/partners/SMW identity, (2) mostly heterosexual, (3) bisexual, and (4) lesbian. We used weighted logistic generalized estimating equations to account for multiple pregnancies per person over time and informative cluster sizes.
Results: The prevalence of each outcome was <5% in pregnancies among all sexual orientation groups. Compared to pregnancies among completely heterosexual women, those among SMW had higher estimated odds of GD (OR[95% CI]: 1.33[1.17–1.52]) and gHTN (1.15[1.03–1.30]) but not PRE-E (1.09[0.97–1.22]). Of note, among SMW subgroups, mostly heterosexual women had higher odds of gHTN (1.29[1.04–1.59]) and heterosexual women with past same-sex attractions/partners/SMW identity had higher odds of GD (1.47[1.26–1.71]), compared to completely heterosexual women.
Conclusions: SMW experience a disparate burden of gHTN and GD. Elucidating the modifiable mechanisms (e.g., structural barriers, discrimination) for reducing pregnancy morbidities among SMW, who remain understudied, is critical for achieving reproductive health equity.