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.
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Supplementary analyses were conducted to test differences between bisexual and lesbian women for analyses. Betas were in the same direction for all models, and no statistical differences were detected between the two groups; thus, they were combined for increased statistical power.
Supplementary analyses included a covariate reflecting pregnancy intention. The inclusion of this variable did not have a significant impact on our results and was thus excluded. Intentions were also excluded because we include pregnancies reported in the past 10 years and measures of intention are generally restricted to the past 5 years in the literature due to recall bias. We also conducted sensitivity analyses that included body mass index (BMI) and alcohol use at time of interview, however, these variables did not impact our results. This, and our inability to correctly time-order these variables led to the decision to exclude them in the final models.
Additional sensitivity analyses were conducted that restricted the sample to pregnancies in the past year. Results of these analyses were similar to those for pregnancies completed in the past 5 and 10 years. However, due to the small sample sizes for lesbian (n = 3) and bisexual (n = 62) women, the results produced large confidence intervals. Thus we did not include these estimates. They are, however, available upon request.
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Everett, B.G., Kominiarek, M.A., Mollborn, S. et al. Sexual Orientation Disparities in Pregnancy and Infant Outcomes. Matern Child Health J 23, 72–81 (2019). https://doi.org/10.1007/s10995-018-2595-x