Sexual orientation-related disparities in obstetrical and perinatal health

项目摘要/摘要 与异性恋女性相比，性少数群体女性(即那些具有同性吸引力的女性， 同性行为和/或女同性恋者/男同性恋者/双性恋者身份)很容易受到妇科健康状况不佳的影响；对于前 在很大程度上，他们更有可能遭遇性侵犯，并遇到护理障碍。然而，尽管 这些妇科差异的证据越来越多，人们对产科和妇科疾病的程度知之甚少 不同性取向人群的围产期健康状况不同。这种差距尤其令人担忧，因为性少数群体 有更多的危险因素(如抑郁、药物使用、肥胖)导致产科和围产期的不良后果- 与异性恋者相比。几乎没有数据可以充分量化与性取向有关的 产科和围产期健康差异，但来自小型横断面数据集的初步结果显示 显著的差异：性少数群体女性的怀孕次数是流产次数的两倍 与异性恋相比，极早产和低出生体重的孩子的数量是异性恋的两倍- 性爱的女人。量化这种差异需要使用大型的纵向数据集来更好地提供信息 干预措施。该项目的目标是解决与性取向相关的产科知识空白 和围产期健康通过收集和分析来自三个独特的、纵向的、代际的 一群人。护士健康研究2(NHS2)始于1989年，当时我们的研究组招募了女护士 年龄25-42岁(现在56-73岁)。在1996年和2004年，我们的研究小组招募了9岁的NHS2后代- 《今日成长研究》(Guts)进行了16年(现在是25-39年)。这些队列包括几乎 15万名参与者的怀孕次数几乎相同，其中包括性早熟患者中的3万例。 领带。拟议的项目将利用现有数据--包括细微差别的性取向数据--来确定 肠道参与者在生育高峰期的新怀孕情况，并收集关于 第三代：GUTS参与者的后代。结合这些新的和现有的数据将使我们能够 填补关键空白，例如通过详细说明不同世代和性取向的结果 群体(例如，双性恋、女同性恋者)。这项研究将量化少数民族和异性恋者的产科健康状况。 性少数群体和异性恋妇女所生子女的围产期健康。 借鉴少数人压力模型，这项研究还将确定性取向的调解人和调解人-- 产科和围产期健康与疾病相关的差异。通过收集三个方面的详细纵向数据 具有产科/围产期结局以及调解人和调解人数据的世代，建议的 研究是对现状的实质性、创新性的背离。这个项目将产生第一个彻底的 被忽视人群的产科和围产期健康评估--少数民族性别性妇女及其配偶 春季-并将通过揭示这些弱势群体的需求产生积极影响，告知有针对性的 干预和改善后代人的健康。

PROJECT SUMMARY/ABSTRACT Compared to heterosexual women, sexual minority women (i.e., those with same-sex attractions, same-sex behavior, and/or a lesbian/gay/bisexual identity) are vulnerable to poor gynecological health; for ex- ample, they are more likely to experience sexual assault and to encounter barriers to care. Yet, despite the mounting evidence of these gynecological disparities, little is known about the extent to which obstetrical and perinatal health differ across sexual orientation groups. This gap is especially troubling since sexual minorities have more risk factors (e.g., depression, substance use, obesity) for adverse obstetrical and perinatal out- comes compared to heterosexuals. Few data are available to adequately quantify sexual orientation-related obstetrical and perinatal health disparities, but preliminary results from small, cross-sectional datasets reveal striking disparities: sexual minority women experience twice the number of pregnancies ending in miscarriage and stillbirth and twice the number of children born extremely preterm and low birthweight compared to hetero- sexual women. Quantifying such disparities necessitates the use of large, longitudinal datasets to better inform interventions. This project's objective is to address the knowledge gaps in sexual orientation-related obstetrical and perinatal health by collecting and analyzing national data from three unique, longitudinal, intergenerational cohorts. The Nurses' Health Study 2 (NHS2) began in 1989 when our research group enrolled female nurses aged 25–42 years (now 56–73 years). In 1996 and 2004, our research group enrolled NHS2 offspring aged 9– 16 years (now 25–39 years) into the Growing Up Today Study (GUTS). These cohorts comprise almost 150,000 participants with nearly as many pregnancies, including >30,000 pregnancies among sexual minori- ties. The proposed project will leverage existing data—including nuanced sexual orientation data—to identify new pregnancies among GUTS participants during the height of their reproductive years and collect data about a third generation: the offspring of GUTS participants. Combining these new and existing data will enable us to fill critical gaps, for example by detailing outcomes across different generations and sexual orientation sub- groups (e.g., bisexuals, lesbians). This study will quantify the obstetrical health of sexual minority and hetero- sexual women as well as the perinatal health of children born to sexual minority and heterosexual women. Drawing on the Minority Stress Model, the study will also identify mediators and moderators of sexual orienta- tion-related differences in obstetrical and perinatal health. By collecting detailed, longitudinal data across three generations with data on obstetrical/perinatal outcomes as well as mediators and moderators, the proposed research is a substantive, innovative departure from the status quo. This project will produce the first thorough evaluation of obstetrical and perinatal health of a neglected population—sexual minority women and their off- spring—and will have a positive impact by revealing the needs of these vulnerable groups, informing targeted interventions and improving the health of subsequent generations.