Health Disparities
Early-Life Trauma, Minority Stress, and Hypertensive Disorders of Pregnancy: Evidence from a Large Prospective Cohort Michelle Tam* Michelle Tam Tam Tam Tam Tam Tam Tam LGBTQ+ Health Center of Excellence and 1Dalla Lana School of Public Health, University of Toronto
Background: Early-life trauma, such as childhood physical and sexual abuse, is linked to hypertensive disorders of pregnancy (HDP) in adulthood. Sexual minority (SM) individuals experience higher rates of childhood abuse and HDP. It is unclear whether sexual orientation modifies the association between early-life trauma and HDP.
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=36,834 pregnancies from 13,854 participants). We assessed type (i.e., physical and sexual abuse) and severity of early-life trauma and prevalence of HDP (i.e., gestational hypertension, preeclampsia) across sexual orientation groups (completely heterosexual, heterosexual with same-sex experiences/mostly heterosexual, and bisexual/lesbian). We used modified Poisson models to estimate risk ratios (RRs).
Results: Compared to completely heterosexual individuals, all SM groups had higher prevalence of childhood physical abuse (ranging from 49.2% to 51.9% vs. 39.8%) and childhood sexual abuse (ranging from 37.1% to 49.4% vs. 27.5%). Pregnancies in all SM groups had higher prevalence of HDP—heterosexual with same-sex experience (9.3%), mostly heterosexual (8.5%), bisexual (9.9%), and lesbian (11%)—compared to the completely heterosexual group (7.3%). Severe physical abuse (risk ratio [RR] 1.19, 95% confidence interval [CI], 1.01–1.41) and sexual abuse (RR 1.12, 95% CI, 1.02–1.24) were associated with increased risk of HDP among all participants compared to no abuse, respectively. Within strata of childhood physical abuse or sexual abuse, no significant differences in HDP were observed across sexual orientation groups.
Conclusion: Both childhood abuse and sexual minority status increase HDP risk, largely through parallel rather than interacting pathways, underscoring the impact of socially patterned trauma on pregnancy health.