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Klittmark S, Niit JKP, Nerström E, Grundström H, Nieminen K, Wells MB, Malmquist A. LBTQ parents' needs for support postpartum following a complicated birth: A matter of reproductive justice. JOURNAL OF LESBIAN STUDIES 2024:1-18. [PMID: 39049779 DOI: 10.1080/10894160.2024.2367869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
LBTQ people have increased risks of complications during birth, risks potentially driven by minority stress and increased levels of mental illness and fear of childbirth. With the aim of exploring reproductive injustices in postpartum care for LBTQ people, we analyzed qualitative interviews where 22 LBTQ birth and non-birth parents shared their experiences of support needs during the postpartum period after births where complications had arisen. Results point to the importance of providing an LBTQ safe space, which includes the need to feel safe regarding one's gender or sexual identity, by avoiding cisheteronormative assumptions and using inclusive language. In the context of recently experiencing birth complications, parents needed a space where they were able to focus on physical and mental healing. The results further show the need for validation of the non-birth parent and inclusive breast/chest-feeding support. Results emphasize the need for more psychosocial support around the birth experience, including better medical support and information during the whole process of childbirth.
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Affiliation(s)
- Sofia Klittmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jaqueline K P Niit
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Nerström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Grundström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katri Nieminen
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michael B Wells
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Malmquist
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Miller ML, Dupree J, Monette MA, Lau EK, Peipert A. Health Equity and Perinatal Mental Health. Curr Psychiatry Rep 2024:10.1007/s11920-024-01521-4. [PMID: 39008146 DOI: 10.1007/s11920-024-01521-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Pregnancy and the postpartum period are vulnerable times to experience psychiatric symptoms. Our goal was to describe existing inequities in perinatal mental health, especially across populations, geography, and in the role of childbirth. RECENT FINDINGS People of color are at an increased risk for perinatal mental health difficulties and more likely to experience neglect, poor communication, and racial discrimination. LGBTQ + individuals encounter unique challenges, implicating the role of heteronormativity, cisnormativity, and gender dysphoria through pregnancy-related processes. Rural-dwelling women are significantly less likely to seek care, be screened for, or receive treatment for perinatal mental health conditions. Trauma-informed, comprehensive mental health support must be provided to all patients during pregnancy, childbirth, and the postpartum period, especially for racially and ethnically minoritized individuals that have often been omitted from care. Future research needs to prioritize inclusion of perinatal populations not well represented in the literature, including rural-dwelling individuals.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Goodman Hall / IU Health Neuroscience Center, Suite 2800 355 W. 16 St. Indianapolis, IN, 46202, Indiana, United States.
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Chakraborty P, Everett BG, Reynolds CA, Hoatson T, Stuart JJ, McKetta SC, Soled KRS, Huang AK, Chavarro JE, Eliassen AH, Obedin-Maliver J, Austin SB, Rich-Edwards JW, Haneuse S, Charlton BM. Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy. Paediatr Perinat Epidemiol 2024. [PMID: 38949425 DOI: 10.1111/ppe.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 07/02/2024]
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.
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Affiliation(s)
- Payal Chakraborty
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bethany G Everett
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Colleen A Reynolds
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jennifer J Stuart
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah C McKetta
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford School of Medicine, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Yang H, Na X, Zhang Y, Xi M, Yang Y, Chen R, Zhao A. Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: a cross sectional study. EClinicalMedicine 2023; 57:101847. [PMID: 36864982 PMCID: PMC9971548 DOI: 10.1016/j.eclinm.2023.101847] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Breastfeeding is essential for the growth and development of all infants. Despite the large transgender and gender-diverse population size, there is no comprehensive research of breastfeeding or chestfeeding practices in this group. This study was designed aimed to investigate the status of breastfeeding or chestfeeding practices in transgender and gender-diverse parents and to explore the possible influencing factors. METHODS A cross-sectional study was conducted between January 27 2022 and February 15 2022 online in China. A representative sample of 647 transgender and gender-diverse parents was enrolled. Validated questionnaires were used to investigate breastfeeding or chestfeeding practices and its associated factors, including physical factors, psychological factors and socio-environmental factors. FINDINGS The exclusive breastfeeding or chestfeeding rate was 33.5% (214) and only 41.3% (244) of infants could be continuously fed until 6 months. Accepting hormonotherapy after having this child (adjusted odds ratio (AOR) = 1.664, 95% confidential interval (CI) = 1.014∼2.738) and receiving feeding education (AOR = 2.161, 95% CI = 1.363∼3.508) were associated with a higher exclusive breastfeeding or chestfeeding rate, while higher gender dysphoria scores (37-47: AOR = 0.549, 95% CI = 0.364∼0.827; >47: AOR = 0.474, 95% CI = 0.286∼0.778), experiencing family violence (15-35: AOR = 0.388, 95% CI = 0.257∼0.583; >35: AOR = 0.335; 95% CI = 0.203∼0.545), experiencing partner violence (≥30: AOR = 0.541, 95% CI = 0.334∼0.867), using artificial insemination (AOR = 0.269, 95% CI = 0.12∼0.541), or surrogacy (AOR = 0.406, 95% CI = 0.199∼0.776) and being discriminated against during seeking of childbearing health care (AOR = 0.402, 95% CI = 0.28∼0.576), are significantly associated with a lower exclusive breastfeeding or chestfeeding rate. Participants who had feeding education were more likely to feed their child with human milk as the first food intake (AOR = 1.644, 95% CI = 1.015∼2.632), while those who had suffered from family violence (>35: AOR = 0.47; 95% CI = 0.259∼0.84), discrimination (AOR = 0.457, 95% CI = 0.284∼0.721) and chose artificial insemination (AOR = 0.304, 95% CI = 0.168∼0.56) or surrogacy (AOR = 0.264, 95% CI = 0.144∼0.489), were less likely to give their child human milk as first food intake. Besides, discrimination is also related to a shorter breastfeeding or chestfeeding duration (AOR = 0.535, 95% CI = 0.375∼0.761). INTERPRETATION Breastfeeding or chestfeeding are neglected health problems in the transgender and gender-diverse population and many socio-demographic factors, transgender and gender-diverse-related factors, and family environment are correlated with it. Better social and family support is necessary to improve breastfeeding or chestfeeding practices. FUNDING There are no funding sources to declare.
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Key Words
- AOR, Adjusted odds ratio
- BCF, Breastfeeding or chestfeeding
- BCFP, Breastfeeding or chestfeeding practice
- Breastfeeding practice
- Chestfeeding
- EBCF, Exclusive breastfeeding or chestfeeding
- FFI, First food intake
- GD, Gender dysphoria
- LGBT, Lesbian, gay, bisexual, and transgender
- LGBTQ, Lesbian, gay, bisexual, transgender, and queer
- OR, Odds ratio
- TGD, Transgender and gender diverse
- TM, Transgender man
- TW, Transgender woman
- Transgender
- UNICEF, United Nations Children's Fund
- WHO, World Health Organization
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Affiliation(s)
- Haibing Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xiaona Na
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yanwen Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Menglu Xi
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yucheng Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
- Corresponding author. Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing, China.
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
- Corresponding author. Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing, China.
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Leonard SA, Berrahou I, Zhang A, Monseur B, Main EK, Obedin-Maliver J. Sexual and/or gender minority disparities in obstetrical and birth outcomes. Am J Obstet Gynecol 2022; 226:846.e1-846.e14. [PMID: 35358492 DOI: 10.1016/j.ajog.2022.02.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many sexual and/or gender minority individuals build families through pregnancy and childbirth, but it is unknown whether they experience different clinical outcomes than those who are not sexual and/or gender minority individuals. OBJECTIVE To evaluate obstetrical and birth outcomes comparing couples who are likely sexual and/or gender minority patients compared with those who are not likely to be sexual and/or gender minority patients. STUDY DESIGN We performed a population-based cohort study of live birth hospitalizations during 2016 to 2019 linked to birth certificates in California. California changed its birth certificate in 2016 to include gender-neutral fields such as "parent giving birth" and "parent not giving birth," with options for each role to specify "mother," "father," or "parent." We classified birthing patients in mother-mother partnerships and those who identified as a father in any partnership as likely sexual and/or gender minority and classified birthing patients in mother-father partnerships as likely not sexual and/or gender minority. We used multivariable modified Poisson regression models to estimate the risk ratios for associations between likely sexual and/or gender minority parental structures and outcomes. The models were adjusted for sociodemographic factors, comorbidities, and multifetal gestation selected by causal diagrams. We replicated the analyses after excluding multifetal gestations. RESULTS In the final birthing patient sample, 1,483,119 were mothers with father partners, 2572 were mothers with mother partners, and 498 were fathers with any partner. Compared with birthing patients in mother-father partnerships, birthing patients in mother-mother partnerships experienced significantly higher rates of multifetal gestation (adjusted risk ratio, 3.9; 95% confidence interval, 3.4-4.4), labor induction (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3), postpartum hemorrhage (adjusted risk ratio, 1.4; 95% confidence interval, 1.3-1.6), severe morbidity (adjusted risk ratio, 1.4; 95% confidence interval, 1.2-1.8), and nontransfusion severe morbidity (adjusted risk ratio, 1.4; 95% confidence interval, 1.1-1.9). Severe morbidity was identified following the Centers for Disease Control and Prevention "severe maternal morbidity" index. Gestational diabetes mellitus, hypertensive disorders of pregnancy, cesarean delivery, preterm birth (<37 weeks' gestation), low birthweight (<2500 g), and low Apgar score (<7 at 5 minutes) did not significantly differ in the multivariable analyses. No outcomes significantly differed between father birthing patients in any partnership and birthing patients in mother-father partnerships in either crude or multivariable analyses, though the risk of multifetal gestation was nonsignificantly higher (adjusted risk ratio, 1.5; 95% confidence interval, 0.9-2.7). The adjusted risk ratios for the outcomes were similar after restriction to singleton gestations. CONCLUSION Birthing mothers with mother partners experienced disparities in several obstetrical and birth outcomes independent of sociodemographic factors, comorbidities, and multifetal gestation. Birthing fathers in any partnership were not at a significantly elevated risk of any adverse obstetrical or birth outcome considered in this study.
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Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; California Maternal Quality Care Collaborative, Palo Alto, CA.
| | - Iman Berrahou
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
| | - Adary Zhang
- Department of Medicine, Stanford University, Stanford, CA
| | - Brent Monseur
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; California Maternal Quality Care Collaborative, Palo Alto, CA
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; Department of Epidemiology and Population Health, Stanford University, Stanford, CA
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Affiliation(s)
- Kathleen Rice Simpson
- Dr. Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist in St. Louis, MO, and the Editor-in-Chief of MCN . Dr. Simpson can be reached via email at
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