Sexual orientation-related disparities in obstetrical and perinatal health

产科和围产期健康中与性取向相关的差异

• 批准号: 10887809
• 负责人: Brittany Michelle Charlton
• 金额: $ 16.6万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-16 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10887809
• 关键词: Address; Adoption; American; Area; Assisted Reproductive Technology; Behavior; Biological Markers; Birth; Bisexual; Child; Child Health; Complex; Couples; Data; Data Collection; Data Set; Dimensions; Discipline of obstetrics; Disparity; Enrollment; Ethnic Origin; Evaluation; Event; Exclusion; Female; Gays; Generations; Goals; Gynecologic; HIV/AIDS; Health; Height; Heterosexuals; Hydrocortisone; Hypertension; Intervention; Knowledge; Legal; Lesbian; Lesbian Gay Bisexual; Longevity; Low Birth Weight Infant; Maternal and Child Health; Mediator; Mental Depression; Modeling; Mothers; Nurses; Nurses' Health Study; Obesity; Outcome; Parents; Participant; Pattern; Perinatal; Policies; Politics; Populations at Risk; Pregnancy; Public Health; Publishing; Race; Reporting; Research; Resources; Rights; Riots; Risk; Risk Factors; Same-sex; Sampling; Sex Orientation; Sociology; Spontaneous abortion; Stress; Subgroup; Testing; United States National Institutes of Health; Vulnerable Populations; Woman; Work; aged; barrier to care; child bearing; cohort; experience; extreme prematurity; gender minority group; health disparity; health disparity populations; improved; infertility treatment; innovation; interest; intergenerational; longitudinal dataset; men; minority stress; neglect; offspring; perinatal health; perinatal outcomes; population health; pregnancy disorder; prenatal; reproductive; same sex behavior; same-sex marriage; same-sex partnership; sex; sexual assault; sexual identity; sexual minority; sexual minority group; sexual minority health; sexual minority women; social; stillbirth; substance use; unintended pregnancy

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.

项目总结/摘要 与异性恋妇女相比，性少数妇女（即，那些有同性吸引力的人， 同性行为，和/或女同性恋/男同性恋/双性恋身份）容易受到妇科健康状况不佳的影响;例如， 此外，她们更有可能遭受性侵犯，并在获得护理方面遇到障碍。然而，尽管 越来越多的证据表明，这些妇科差异，鲜为人知的是，在多大程度上，产科和 性取向群体的围产期健康状况各不相同。这种差距尤其令人不安，因为性少数群体 有更多的风险因素（例如，抑郁症，物质使用，肥胖症）的不良产科和围产期外- 与异性恋者相比。很少有数据可以充分量化与性取向有关的 产科和围产期健康的差异，但从小，横截面数据集的初步结果显示， 惊人的差异：性少数妇女经历两倍的怀孕以流产告终 和死产，以及与异性恋相比，极端早产和低出生体重的儿童数量是异性恋的两倍， 性感的女人量化这种差异需要使用大型纵向数据集，以更好地了解 干预措施。该项目的目标是解决与性取向有关的产科知识差距， 通过收集和分析来自三个独特的，纵向的，代际的国家数据， 同伙护士健康研究2（NHS 2）始于1989年，当时我们的研究小组招募了女护士 年龄25-42岁（现56-73岁）。在1996年和2004年，我们的研究小组招募了9岁的NHS 2后代， 16年（现在25-39岁）进入今天的成长研究（GUTS）。这些群体几乎包括 150，000名参与者几乎有同样多的怀孕，其中包括性实里人中的30，000例怀孕- 关系的拟议的项目将利用现有的数据-包括细微差别的性取向数据-以确定 GUTS参与者在生育高峰期的新怀孕，并收集有关 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，通过详细说明不同代人和性取向亚群体的成果， 组（例如，双性恋者、女同性恋者）。这项研究将量化性少数和异性恋的产科健康， 性取向少数妇女和异性恋妇女所生子女的围产期健康。 根据少数民族压力模型，这项研究还将确定性取向的调解人和调解人， 产科和围产期健康方面与生育有关的差异。通过收集三个方面的详细纵向数据， 提供关于产科/围产期结果以及调解人和调节人的数据， 研究是从现状出发的实质性创新。该项目将产生第一个彻底的 评估被忽视人口的产科和围产期健康-性少数群体妇女及其非亲 春天，并将产生积极的影响，揭示这些弱势群体的需求， 干预和改善后代的健康。