Trans identification not tied to worse pregnancy outcomes

Transgender, nonbinary, and gender-diverse (trans) identification at the time of delivery is not significantly associated with severe parental morbidity or preterm birth, according to a research letter published online May 11 in the Journal of the American Medical Association.

Daphna Stroumsa, M.D., M.P.H., from University of Michigan in Ann Arbor, and colleagues analyzed all deliveries from 2014 to 2018 from the Truven MarketScan Medicaid and commercial databases to identify pregnancy outcomes for patients with male gender at the time of delivery. The analysis included 256 trans people in the Medicaid database and 1,651 trans people in the commercial database who had a delivery. In the Medicaid database, trans people were younger, less likely to be White, and more likely to have a chronic condition. In the commercial database, trans people had higher rates of some chronic conditions, such as anxiety or depression.

The researchers observed no significant association between trans identification and severe parental morbidity (Medicaid: adjusted odds ratio [OR], 1.28; 95 percent confidence interval [CI], 0.29 to 5.57; P = 0.75; commercial: adjusted OR, 1.62; 95 percent CI, 0.98 to 2.69; P = 0.06) or preterm birth (Medicaid: adjusted OR, 1.37; 95 percent CI, 0.94 to 2.01; P = 0.99; commercial: adjusted OR, 0.90; 95 percent CI, 0.75 to 1.09; P = 0.28). Trans identification was associated with a lower odds of cesarean delivery (Medicaid: adjusted OR, 0.47; 95 percent CI, 0.25 to 0.88; P = 0.02; commercial: adjusted OR, 0.55; 95 percent CI, 0.45 to 0.66; P < 0.001).

"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 authors write.