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. 2024 Sep;38(7):545-556.
doi: 10.1111/ppe.13101. Epub 2024 Jul 1.

Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy

Payal Chakraborty  1   2 , Bethany G Everett  3 , Colleen A Reynolds  1   2 , Tabor Hoatson  1 , Jennifer J Stuart  2   4 , Sarah C McKetta  1   2 , Kodiak R S Soled  1 , Aimee K Huang  1   5 , Jorge E Chavarro  2   6   7 , A Heather Eliassen  2   6   7 , Juno Obedin-Maliver  8   9 , S Bryn Austin  5   10 , Janet W Rich-Edwards  2   4 , Sebastien Haneuse  11 , Brittany M Charlton  1   2   7   10
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Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy

Payal Chakraborty et al. Paediatr Perinat Epidemiol. 2024 Sep.

Abstract

Background: Sexual 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).

Objective: To estimate disparities in GDM, gHTN and preeclampsia by sexual orientation.

Methods: We 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.

Results: The 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.

Conclusions: Some 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.

Keywords: United States; gestational diabetes; gestational hypertension; preeclampsia; sexual orientation.

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Conflict of interest statement

Author Disclosure: JJS is now a salaried employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, United States. No other competing financial interests exist.

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