Perinatal & Pediatric
Trauma, post-traumatic stress disorder symptoms, and adverse pregnancy outcomes: sexual orientation disparities in a prospective cohort study Michelle W. Tam* Michelle Tam Isa Berzansky Payal Chakraborty Colleen A. Reynolds Kodiak Soled Sarah McKetta Cindy Veldhuis Karestan Koenen Brittany Charlton
Background: Sexual minority (SM) individuals are at heightened risk for trauma exposure and post-traumatic stress disorder (PTSD) symptoms, as well as adverse pregnancy outcomes. Yet, little research has elucidated the link between trauma histories, PTSD symptoms, and adverse pregnancy outcomes in this population.
Methods: The Nurses’ Health Study 3 is a longitudinal cohort of nurses born on or after January 1, 1965, living in the US or Canada (N= 27,359 pregnancies from 10,086 participants). We estimated person-level prevalence of traumatic events and PTSD symptoms, and pregnancy-level prevalence of adverse pregnancy outcomes (i.e., gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth, low birthweight, macrosomia) across sexual orientation groups (completely heterosexual, heterosexual with same-sex experience, mostly heterosexual, bisexual, and lesbian/gay). Moderation analyses examining adverse pregnancy outcomes across sexual orientation and PTSD/trauma are forthcoming.
Results: Compared to completely heterosexual individuals, mean age at first traumatic event was younger for all SM groups; completely heterosexual individuals were 18.5 years, heterosexual with same-sex experience (16.1 years), mostly heterosexual (15.8 years), bisexual (13.9 years), and lesbian/gay (12.9 years). All SM groups had a higher prevalence of PTSD symptoms— bisexual (74%), lesbian/gay (71%), mostly heterosexual (67%), heterosexual with same-sex experience (58%)—compared to the completely heterosexual group (55%). Pregnancies to lesbian/gay individuals (36%) had the highest prevalence of any adverse pregnancy outcomes, followed by completely heterosexual (30%), heterosexual with same-sex experience (28%), bisexual (27%), and mostly heterosexual (27%).
Conclusions: Future research should investigate mechanisms underlying sexual orientation-related inequities (e.g., discrimination and minority stress) in traumatic experiences, PTSD, and adverse pregnancy outcomes.