Sexual Orientation Disparities in Pregnancy and Infant Outcomes
Objectives Little is known about maternal and infant health among sexual minority women (SMW), despite the large body of research documenting their multiple preconception risk factors. This study used data from the 2006–2015 National Survey of Family Growth (NSFG) to investigate sexual orientation inequities in pregnancy and birth outcomes, including miscarriage, stillbirth, preterm birth, and birth weight. Methods Women reported 19,955 study eligible pregnancies and 15,996 singleton live births. Sexual orientation was measured using self-reported identity and histories of same-sex sexual experiences (heterosexual-WSM [women who only report sex with men]; heterosexual-WSW [women who report sex with women]; bisexual, and lesbian). Logistic regression models were used that adjusted for several maternal characteristics. Results Compared to heterosexual-WSM, heterosexual-WSW (OR 1.25, 95% CI 1.00–1.58) and bisexual and lesbian women (OR 1.77, 95% CI 1.34–2.35) were more likely to report miscarriage, and bisexual and lesbian women were more likely to report a pregnancy ending in stillbirth (OR 2.85, 95% CI 1.40–5.83). Lesbian women were more likely to report low birth weight infants (OR 2.64, 95% CI 1.38–5.07) and bisexual and lesbian women were more likely to report very preterm births (OR 1.84, 95% CI 1.11–3.04) compared to heterosexual-WSM. Conclusions for Practice This study documents significant sexual orientation inequities in pregnancy and birth outcomes. More research is needed to understand the mechanisms that underlie disparate outcomes and to develop interventions to improve sexual minority women’s maternal and infant health.
KeywordsMaternal health Health inequities Sexual orientation Sexual minority women
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- Earnshaw, V. A., Rosenthal, L., Lewis, J. B., Stasko, E. C., Tobin, J. N., Lewis, T. T., … Ickovics, J. R. (2012). Maternal experiences with everyday discrimination and infant birth weight: A test of mediators and moderators among young, urban women of color. Annals of Behavioral Medicine, 45(1), 13–23.CrossRefGoogle Scholar
- Goldberg, A. E., Gartrell, N., & Gates, G. J. (2014). Research report on LGB-parent families 2014 Los Angeles, CA. Retrieved from the Williams Institute website http://williamsinstitute.law.ucla.edu/wp-content/uploads/lgb-parent-families-july-2014.pdf.
- Krieger, N., Chen, J. T., Coull, B., Waterman, P. D., & Beckfield, J. (2013). The unique impact of abolition of Jim Crow laws on reducing inequities in infant death rates and implications for choice of comparison groups in analyzing societal determinants of health. American Journal of Public Health, 103(12), 2234–2244.CrossRefGoogle Scholar
- MacDorman, M. (2014). International comparisons of infant mortality and related factors: United States and Europe, 2010. National Vital Statistics Report, 63(5), 1–6.Google Scholar
- National Survey of Family Growth Users Guide Pt 2: Topic specific notes for analysis. Accessed June, 2017, from https://www.cdc.gov/nchs/data/nsfg/nsfg_2011-2013_userguide_maintext.pdf.
- National Survey of Family Growth: 2013–2015 NSFG Sample Design Documentation. Accessed May, 2017, from https://www.cdc.gov/nchs/data/nsfg/NSFG_2013-2015_Sample_Design_Documentation.pdf.
- Xu, F., Sternberg, M. R., & Markowitz, L. E. (2010). Women who have sex with women in the United States: Prevalence, sexual behavior and prevalence of herpes simplex virus type 2 infection-results from national health and nutrition examination survey 2001–2006. Sexually Transmitted Diseases, 37(7), 407–413.Google Scholar