Sexual and/or gender minority disparities in obstetrical and birth outcomes

Many sexual and/or gender minority individuals build families through pregnancy and childbirth, but it is unknown whether they experience different clinical outcomes than those who are not sexual and/or gender minority individuals. To evaluate obstetrical and birth outcomes comparing couples who are...

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Veröffentlicht in:American journal of obstetrics and gynecology 2022-06, Vol.226 (6), p.846.e1-846.e14
Hauptverfasser: Leonard, Stephanie A., Berrahou, Iman, Zhang, Adary, Monseur, Brent, Main, Elliott K., Obedin-Maliver, Juno
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Sprache:eng
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Zusammenfassung:Many sexual and/or gender minority individuals build families through pregnancy and childbirth, but it is unknown whether they experience different clinical outcomes than those who are not sexual and/or gender minority individuals. To evaluate obstetrical and birth outcomes comparing couples who are likely sexual and/or gender minority patients compared with those who are not likely to be sexual and/or gender minority patients. We performed a population-based cohort study of live birth hospitalizations during 2016 to 2019 linked to birth certificates in California. California changed its birth certificate in 2016 to include gender-neutral fields such as “parent giving birth” and “parent not giving birth,” with options for each role to specify “mother,” “father,” or “parent.” We classified birthing patients in mother-mother partnerships and those who identified as a father in any partnership as likely sexual and/or gender minority and classified birthing patients in mother-father partnerships as likely not sexual and/or gender minority. We used multivariable modified Poisson regression models to estimate the risk ratios for associations between likely sexual and/or gender minority parental structures and outcomes. The models were adjusted for sociodemographic factors, comorbidities, and multifetal gestation selected by causal diagrams. We replicated the analyses after excluding multifetal gestations. In the final birthing patient sample, 1,483,119 were mothers with father partners, 2572 were mothers with mother partners, and 498 were fathers with any partner. Compared with birthing patients in mother-father partnerships, birthing patients in mother-mother partnerships experienced significantly higher rates of multifetal gestation (adjusted risk ratio, 3.9; 95% confidence interval, 3.4–4.4), labor induction (adjusted risk ratio, 1.2; 95% confidence interval, 1.1–1.3), postpartum hemorrhage (adjusted risk ratio, 1.4; 95% confidence interval, 1.3–1.6), severe morbidity (adjusted risk ratio, 1.4; 95% confidence interval, 1.2–1.8), and nontransfusion severe morbidity (adjusted risk ratio, 1.4; 95% confidence interval, 1.1–1.9). Severe morbidity was identified following the Centers for Disease Control and Prevention “severe maternal morbidity” index. Gestational diabetes mellitus, hypertensive disorders of pregnancy, cesarean delivery, preterm birth (
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2022.02.041