Sexual Orientation Disparities in Pregnancy and Infant Outcomes

Abstract

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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Notes

  1. 1.

    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.

  2. 2.

    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.

  3. 3.

    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.

References

  1. Aaron, D. J., & Hughes, T. L. (2007). Association of childhood sexual abuse with obesity in a community sample of lesbians. Obesity, 15(4), 1023–1028.

    Article  PubMed  Google Scholar 

  2. Adams, J., & Light, R. (2015). Scientific consensus, the law, and same sex parenting outcomes. Social Science Research, 53, 300–310.

    Article  PubMed  Google Scholar 

  3. Almeida, J., Johnson, R. M., Corliss, H. L., Molnar, B. E., & Azrael, D. (2009). Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 38(7), 1001–1014.

    Article  PubMed  PubMed Central  Google Scholar 

  4. American College of Obstetrics and Gynecology. (2012). ACOG Committee Opinion No. 525: Health care for lesbians and bisexual women. Obstetrics and Gynecology, 119(5), 1077–1080.

    Article  Google Scholar 

  5. Bell, A. V., Ompad, D., & Sherman, S. G. (2006). Sexual and drug risk behaviors among women who have sex with women. American Journal of Public Health, 96(6), 1066–1072.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Blumenshine, P., Egerter, S., Barclay, C. J., Cubbin, C., & Braveman, P. A. (2010). Socioeconomic disparities in adverse birth outcomes: A systematic review. American Journal of Preventive Medicine, 39(3), 263–272.

    Article  PubMed  Google Scholar 

  7. Bowen, D. J., Balsam, K. F., & Ender, S. R. (2012). A review of obesity issues in sexual minority women. Obesity, 16(2), 221–228.

    Article  Google Scholar 

  8. Braveman, P., Heck, K., Egerter, S., Dominguez, T. P., Rinki, C., Marchi, K. S., & Curtis, M. (2017). Worry about racial discrimination: A missing piece of the puzzle of Black-White disparities in preterm birth? PLoS ONE, 12(10), e0186151.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Buchmueller, T., & Carpenter, C. S. (2010). Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. American Journal of Public Health, 100(3), 489–495.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Collins, J. W., David, R. J., Handler, A., Wall, S., & Andes, S. (2004). Very low birthweight in African American infants: The role of maternal exposure to interpersonal racial discrimination. American Journal of Public Health, 94(12), 2132–2138.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dahl, B., Fylkesnes, A. M., Sørlie, V., & Malterud, K. (2013). Lesbian women’s experiences with healthcare providers in the birthing context: A meta-ethnography. Midwifery, 29(6), 674–681.

    Article  PubMed  Google Scholar 

  12. Daniel, H., & Butkus, R. (2015). Lesbian, gay, bisexual, and transgender health disparities: Executive summary of a policy position paper from the American College of PhysiciansLGBT Health Disparities. Annals of Internal Medicine, 163(2), 135–137.

    Article  PubMed  Google Scholar 

  13. Diamond, L. M. (2003). Was it a phase? Young women’s relinquishment of lesbian/bisexual identities over a 5-year period. Journal of Personality and Social Psychology, 84(2), 352–364.

    Article  PubMed  Google Scholar 

  14. Dole, N., Savitz, D. A., Hertz-Picciotto, I., Siega-Riz, A. M., McMahon, M. J., & Buekens, P. (2003). Maternal stress and preterm birth. American Journal of Epidemiology, 157(1), 14–24.

    Article  CAS  PubMed  Google Scholar 

  15. Dunkel Schetter, C. (2011). Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62, 531–558.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. Entringer, S., Buss, C., & Wadhwa, P. D. (2015). Prenatal stress, development, health and disease risk: A psychobiological perspective—2015 Curt Richter Award Paper. Psychoneuroendocrinology, 62, 366–375.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Everett, B. G., McCabe, K. F., & Hughes, T. L. (2017). Sexual orientation disparities in mistimed and unwanted pregnancy among adult women. Perspectives on Sexual and Reproductive Health, 49(3), 157–165.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Everett, B. G., & Mollborn, S. (2014). Examining sexual orientation disparities in unmet medical needs among men and women. Population Research and Policy Review, 33(4), 553–577.

    Article  PubMed  Google Scholar 

  20. Everett, B. G., Talley, A. E., Hughes, T. L., Wilsnack, S. C., & Johnson, T. P. (2016). Sexual identity mobility and depressive symptoms: A longitudinal analysis of moderating factors among sexual minority women. Archives of Sexual Behavior, 45(7), 1731–1744.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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.

  22. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hoffman, M. C., Mazzoni, S. E., Wagner, B. D., Laudenslager, M. L., & Ross, R. G. (2016). Measures of maternal stress and mood in relation to preterm birth. Obstetrics & Gynecology, 127(3), 545–552.

    Article  Google Scholar 

  24. Hughes, T. (2011). Alcohol use and alcohol-related problems among sexual minority women. Alcoholism Treatment Quarterly, 29(4), 403–435.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Jeong, Y. M., Veldhuis, C., Aranda, F., & Hughes, T. L. (2016). Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women. Journal of Clinical Nursing, 25(23–24), 3557–3569.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Juster, R.-P., Hatzenbuehler, M. L., Mendrek, A., Pfaus, J. G., Smith, N. G., Johnson, P. J., … Pruessner, J. C. (2015). Sexual orientation modulates endocrine stress reactivity. Biological Psychiatry, 77(7), 668–676.

    Article  CAS  PubMed  Google Scholar 

  27. Katz-Wise, S. L., & Hyde, J. S. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. Journal of Sex Research, 49(2–3), 142–167.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lilliecreutz, C., Larén, J., Sydsjö, G., & Josefsson, A. (2016). Effect of maternal stress during pregnancy on the risk for preterm birth. BMC Pregnancy and Childbirth, 16, 5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 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 

  31. Malmquist, A., & Nelson, K. Z. (2013). Efforts to maintain a “just great” story: Lesbian parents’ talk about encounters with professionals in fertility clinics and maternal and child healthcare services. Feminism & Psychology, 24(1), 56–73.

    Article  Google Scholar 

  32. Manning, W. D., Fettro, M. N., & Lamidi, E. (2014). Child well-being in same-sex parent families: Review of research prepared for American Sociological Association Amicus Brief. Population Research and Policy Review, 33(4), 485–502.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Marshal, M. P., Friedman, M. S., Stall, R., & Thompson, A. L. (2009). Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth. Addiction, 104(6), 974–981.

    Article  PubMed  PubMed Central  Google Scholar 

  34. McCabe, S. E., Hughes, T. L., Matthews, A. K., Lee, J. G. L., West, B. T., Boyd, C. J., & Arslanian-Engoren, C. (2017). Sexual orientation discrimination and tobacco use disparities in the United States. Nicotine and Tobacco Research. https://doi.org/10.1093/ntr/ntx283.

    Article  Google Scholar 

  35. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56.

    Article  CAS  Google Scholar 

  36. 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.

  37. 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.

  38. Przedworski, J. M., McAlpine, D. D., Karaca-Mandic, P., & VanKim, N. A. (2014). Health and health risks among sexual minority women: An examination of 3 subgroups. American Journal of Public Health, 104(6), 1045–1047.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Reed, S. J., Miller, R. L., & Timm, T. (2011). Identity and agency the meaning and value of pregnancy for young black lesbians. Psychology of Women Quarterly, 35(4), 571–581.

    Article  Google Scholar 

  40. Ross, L. E., Siegel, A., Dobinson, C., Epstein, R., & Steele, L. S. (2012). “I don’t want to turn totally invisible”: Mental health, stressors, and supports among bisexual women during the perinatal period. Journal of GLBT Family Studies, 8(2), 137–154.

    Article  Google Scholar 

  41. Smith, L. K., Draper, E. S., Manktelow, B. N., Dorling, J. S., & Field, D. J. (2007). Socioeconomic inequalities in very preterm birth rates. Archive of Diseases in Childhood: Fetal and Neonatal, 92(1), F11–F14.

    Article  CAS  Google Scholar 

  42. Willinger, M., Ko, C.-W., & Reddy, U. M. (2009). Racial disparities in stillbirth risk across gestation in the United States. American Journal of Obstetrics and Gynecology, 201(5), 469.e1–469.e8.

    Article  Google Scholar 

  43. 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.

    PubMed  Google Scholar 

  44. Yager, C., Brennan, D., Steele, L. S., Epstein, R., & Ross, L. E. (2010). Challenges and mental health experiences of lesbian and bisexual women who are trying to conceive. Health & Social Work, 35(3), 191–200.

    Article  Google Scholar 

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Correspondence to Bethany G. Everett.

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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

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Keywords

  • Maternal health
  • Health inequities
  • Sexual orientation
  • Sexual minority women