Similar rates of parental morbidity, preterm birth for transgender, cisgender parents

Key takeaways:

• Transgender people with commercial insurance had similar severe parental morbidity rates as cisgender people.
• Those with commercial or public insurance had lower rates of cesarean delivery vs. cisgender people.

Among people who gave birth between 2014 and 2018, those who identified as transgender experienced similar rates of severe parental morbidity and preterm birth as cisgender parents regardless of insurance type, researchers reported in JAMA.

In addition, transgender parents had a lower rate of cesarean delivery than cisgender parents, according to the researchers.

“Trans individuals can and do become pregnant, but there are limited data regarding pregnancy outcomes. Prenatal care access barriers, minority stress and stigma, and prior or ongoing use of testosterone may place trans people at heightened risk of perinatal complications,” Daphna Stroumsa, MD, MPH, MSc, assistant professor in the department of obstetrics and gynecology at the University of Michigan at Ann Arbor, and colleagues wrote. “We evaluated pregnancy outcomes among commercially and publicly insured trans people.”

From 2014 to 2018, Stroumsa and colleagues assessed data on all deliveries from 256 transgender people and 1,255,942 cisgender people with public health insurance from the Truven MarketScan Medicaid database. Researchers also assessed data on all deliveries from 1,651 transgender people and 1,465,565 cisgender people with commercial insurance. The primary outcome was severe parental morbidity. Secondary outcomes included cesarean delivery and preterm birth.

Transgender people with public insurance were younger (mean age, 26.65 vs. 23.48 years), less likely to be white (49.8% vs. 33.6%) and more likely to have chronic conditions (14.9% vs. 22.7%) compared with cisgender people with public insurance. Compared with cisgender people with commercial insurance, transgender people with commercial insurance experienced higher rates of chronic conditions, including anxiety or depression (3.4% vs. 5.5%).

Transgender people from both the Medicaid (21.1% vs. 27.7%) and commercial (21.9% vs. 33.7%) databases experienced significantly lower rates of cesarean delivery compared with cisgender people. Researchers noted no significant difference in rates of preterm birth in either the Medicaid (transgender, 12.9% vs. cisgender, 11.3%) or commercial (transgender, 8.1% vs. cisgender, 8.6%) databases.

In multivariable analysis, identifying as transgender was not significantly associated with severe parental morbidity in Medicaid (adjusted OR = 1.28; 95% CI, 0.29-5.57; P = .75) or commercial (aOR = 1.62; 95% CI, 0.98-2.69; P = .06) databases, nor was it associated with preterm birth odds in Medicaid (aOR = 1.37; 95% CI, 0.94-2.01; P = .99) or commercial (aOR = 0.9; 95% CI, 0.75-1.09; P = .28) databases. However, identifying as transgender was associated with lower odds of cesarean delivery in Medicaid (aOR = 0.47; 95% CI, 0.25-0.88) and commercial (aOR = 0.55; 95% CI, 0.45-0.66) databases.

“Prospective data and larger sample sizes, as well as studies evaluating patient-reported outcomes, are needed to better characterize birth outcomes and for future quality improvement,” the researchers wrote.