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: 10476070
• 负责人: Brittany Michelle Charlton
• 金额: $ 87.96万
• 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/10476070
• 关键词: AIDS/HIV problem; 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; Disease; Enrollment; Ethnic Origin; Evaluation; Event; Female; Gays; Generations; Goals; Health; Height; Heterosexuals; Hydrocortisone; Intervention; Knowledge; Legal; Lesbian; Lesbian Gay Bisexual; Longevity; Low Birth Weight Infant; Maternal and Child Health; Mediator of activation protein; Mental Depression; Minority; Minority Groups; Modeling; Mothers; Nurses; Nurses' Health Study; Obesity; Outcome; Parents; Participant; Pattern; Perinatal; Policies; Politics; Population; Pregnancy; Public Health; Publishing; Race; Reporting; Research; Rights; Riots; Risk; Risk Factors; Same-sex; Sampling; Sex Orientation; Sexual Health; Sexual and Gender Minorities; Sociology; Source; Spontaneous abortion; Stress; Subgroup; Testing; United States National Institutes of Health; Vulnerable Populations; Woman; Work; aged; barrier to care; child bearing; cohort; experience; health disparity; health disparity populations; improved; infertility treatment; innovation; interest; intergenerational; longitudinal dataset; men; neglect; obstetric outcomes; offspring; perinatal health; perinatal outcomes; population health; pregnancy disorder; prenatal; reproductive; same sex behavior; same-sex marriage; same-sex partnership; sex; sexual assault; sexual disparity; sexual minority; 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.

项目概要/摘要 与异性恋女性相比，性少数女性（即那些具有同性吸引力、 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；对于前 更重要的是，他们更有可能遭受性侵犯并遇到护理障碍。然而，尽管 越来越多的证据表明这些妇科差异，但人们对产科和妇科差异的程度知之甚少。 不同性取向群体的围产期健康状况有所不同。这种差距尤其令人不安，因为性少数群体 有更多导致不良产科和围产期并发症的危险因素（例如抑郁、药物滥用、肥胖） 与异性恋者相比。很少有数据可以充分量化与性取向相关的 产科和围产期健康差异，但小型横截面数据集的初步结果显示 显着差异：性少数女性的怀孕流产次数是女性的两倍 和死产以及极端早产和低出生体重的儿童数量是异性恋婴儿的两倍 性女性。量化这种差异需要使用大型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差距 和围产期健康，通过收集和分析来自三个独特的、纵向的、代际的国家数据 队列。护士健康研究 2 (NHS2) 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）。 1996 年和 2004 年，我们的研究小组招募了 9 岁至 9 岁的 NHS2 后代 开展今日成长研究 (GUTS) 已有 16 年（现在 25-39 岁）。这些群体几乎包括 150,000 名参与者的怀孕次数几乎与此相同，其中性少数群体的怀孕次数超过 30,000 人 关系。拟议的项目将利用现有数据（包括细致入微的性取向数据）来识别 GUTS 参与者在生育高峰期的新怀孕情况，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，例如详细说明不同代际的结果和性取向亚 群体（例如双性恋、女同性恋）。这项研究将量化性少数和异性恋的产科健康 性女性以及性少数和异性恋女性所生子女的围产期健康。 借鉴少数民族压力模型，该研究还将确定性取向的中介者和调节者。 产科和围产期健康的相关差异。通过收集三个方面的详细纵向数据 具有产科/围产期结果数据以及中介因素和调节因素的几代人，建议 研究是对现状的实质性、创新性的偏离。该项目将产生第一个彻底的 对被忽视人群——性少数妇女及其后代——的产科和围产期健康进行评估 春季——并将通过揭示这些弱势群体的需求、向目标群体提供信息来产生积极影响 干预措施并改善子孙后代的健康。