Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy

Author:

Chakraborty Payal12ORCID,Everett Bethany G.3,Reynolds Colleen A.12ORCID,Hoatson Tabor1,Stuart Jennifer J.24,McKetta Sarah C.12,Soled Kodiak R. S.1ORCID,Huang Aimee K.15,Chavarro Jorge E.267,Eliassen A. Heather267,Obedin‐Maliver Juno89,Austin S. Bryn510,Rich‐Edwards Janet W.24,Haneuse Sebastien11,Charlton Brittany M.12710

Affiliation:

1. Department of Population Medicine Harvard Medical School & Harvard Pilgrim Health Care Institute Boston Massachusetts USA

2. Department of Epidemiology Harvard T.H. Chan School of Public Health Boston Massachusetts USA

3. Department of Sociology University of Utah Salt Lake City Utah USA

4. Division of Women's Health, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA

5. Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston Massachusetts USA

6. Department of Nutrition Harvard T.H. Chan School of Public Health Boston Massachusetts USA

7. Channing Division of Network Medicine Harvard Medical School and Brigham and Women's Hospital Boston Massachusetts USA

8. Department of Obstetrics and Gynecology Stanford School of Medicine Palo Alto California USA

9. Department of Epidemiology and Population Health Stanford University School of Medicine Palo Alto California USA

10. Division of Adolescent/Young Adult Medicine Boston Children's Hospital Boston Massachusetts USA

11. Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts USA

Abstract

AbstractBackgroundSexual minority (SM) individuals (e.g., those with same‐sex attractions/partners or who identify as lesbian/gay/bisexual) experience a host of physical and mental health disparities. However, little is known about sexual orientation‐related disparities in gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP; gestational hypertension [gHTN] and preeclampsia).ObjectiveTo estimate disparities in GDM, gHTN and preeclampsia by sexual orientation.MethodsWe used data from the Nurses' Health Study II—a cohort of nurses across the US enrolled in 1989 at 25–42 years of age—restricted to those with pregnancies ≥20 weeks gestation and non‐missing sexual orientation data (63,518 participants; 146,079 pregnancies). Our primary outcomes were GDM, gHTN and preeclampsia, which participants reported for each of their pregnancies. Participants also reported their sexual orientation identity and same‐sex attractions/partners. We compared the risk of each outcome in pregnancies among heterosexual participants with no same‐sex experience (reference) to those among SM participants overall and within subgroups: (1) heterosexual with same‐sex experience, (2) mostly heterosexual, (3) bisexual and (4) lesbian/gay participants. We used modified Poisson models to estimate risk ratios (RR) and 95% confidence intervals (CI), fit via weighted generalised estimating equations, to account for multiple pregnancies per person over time and informative cluster sizes.ResultsThe overall prevalence of each outcome was ≤5%. Mostly heterosexual participants had a 31% higher risk of gHTN (RR 1.31, 95% CI 1.03, 1.66), and heterosexual participants with same‐sex experience had a 31% higher risk of GDM (RR 1.31, 95% CI 1.13, 1.50), compared to heterosexual participants with no same‐sex experience. The magnitudes of the risk ratios were high among bisexual participants for gHTN and preeclampsia and among lesbian/gay participants for gHTN.ConclusionsSome SM groups may be disparately burdened by GDM and HDP. Elucidating modifiable mechanisms (e.g., structural barriers, discrimination) for reducing adverse pregnancy outcomes among SM populations is critical.

Funder

National Institutes of Health

Health Resources and Services Administration

National Cancer Institute

Publisher

Wiley

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