Health Disparities
Sexual orientation disparities in unintended pregnancies and pregnancy outcomes Payal Chakraborty* Payal Chakraborty Payal Chakraborty Corinne H. Rocca Colleen A. Reynolds Kodiak R.S. Soled Sarah McKetta Natalia Linos Ange-Marie Hancock Danielle Bessett Sebastien Haneuse Brittany M. Charlton
Background: Sexual minority (SM) people may be at increased risk of unintended (mistimed or unwanted) pregnancies. Yet, little research has examined sexual orientation differences in unintended pregnancies and their outcomes.
Methods: We pooled data from two cohorts, the Nurses’ Health Study 3 and Growing Up Today Study (analytic N=19,031 pregnancies 1978–2024). We fit multinomial models to estimate associations between mistimed and unwanted (vs. intended) pregnancies comparing completely heterosexual participants and four SM groups (heterosexual with same-sex experience, mostly heterosexual, bisexual, and lesbian/gay). We used generalized estimating equations (GEE) with inverse probability of treatment weights (IPTW) and inverse cluster size weights (ICSW) to address multiple pregnancies per person, confounding, and informative clustering. Within strata of intended, mistimed, and unwanted pregnancies—using log-binomial GEE models with IPTW/ICSW—we examined differences in induced abortion and negative perinatal outcomes (pregnancy loss, preterm birth, low birthweight, gestational hypertension/diabetes, preeclampsia) by sexual orientation.
Results: Compared to pregnancies to completely heterosexual participants, all SM groups had higher unwanted vs. intended pregnancies (RRRs from 1.42–5.92). Those to mostly heterosexual (RRR: 1.27, 95% CI: 1.16–1.40) and bisexual (1.73, 95% CI: 1.39–2.15) participants were more likely to be mistimed vs. intended. Intended, mistimed, and unwanted pregnancies to all SM groups were more likely to end in abortions. Mistimed pregnancies to bisexual (RR: 1.67, 1.07–2.60) and lesbian/gay (3.51, 1.60–7.69) participants were more likely to end in loss.
Conclusions: SM people had higher induced abortion use for unintended pregnancies, possibly suggesting positive care access. SM inequities in pregnancy loss are higher in mistimed pregnancies. Disparities in unintended pregnancies must be addressed to ensure reproductive autonomy for all.
