Maternal Health in the Transgender Population

Abstract

Social acceptance and legal protections for transgender and gender nonconforming patients have increased over the past decade, but significant health care disparities still remain. Such an area of disparity is discussion with and interventions for fertility, contraception, pregnancy, and lactation in TGNC patients. Providing optimal care starts with creating a welcoming and safe environment. Appropriate preconception education includes the effects of gender-affirming therapies (both surgical and nonsurgical) on fertility as well the fertility preservation techniques that are available. However, as gamete retrieval requires natal hormone stimulation, gender dysphoria may be worsened. Thus, these patients should be carefully monitored not only medically, but also with regard to their mental health. In addition to assisted reproductive technologies, protocols exist to aid with induction of lactation as well as discontinuation if desired. As this is a growing field of medicine with limited data available on safety and long-term outcomes, recommendations are for a multidisciplinary team approach to ensure patients' safety and well-being.

Indução da lactação em mulheres transgênero: Uma revisão integrativa da literatura

“…Embora os relatos de caso publicados na literatura tenham utilizado doses diárias acima de 30 mg, é necessário enfatizar que há o risco de eventos adversos graves, como arritmias cardíacas, parada cardiorrespiratória e morte súbita no adulto (Paynter, 2019;Arnold & Beaves, 2013;Camilleri et al, 2013). Por conta disso, sua venda não é aprovada nos Estados Unidos da América (EUA) (Garcia-Acosta et al, 2019) -todavia, sua venda é permitida em países como Canadá e Brasil (Patel & Sweeney, 2021).…”

“…A metoclopramida é outro fármaco que pode ser utilizado como galactagogo, mas também não é recomendado nos EUA pela sua alta taxa de excreção no leite (Patel & Sweeney, 2021;Ferri et al, 2020;Paynter, 2019). Há descrito também plantas medicinais com efeitos galactagogos, mas as evidências acerca de sua eficácia e dos seus riscos são escassas (Kwan & Abdul-Rahman, 2021;Ferri et al, 2020).…”

Reconceiving Reproductive Health Systems: Caring for Trans, Nonbinary, and Gender-Expansive People During Pregnancy and Childbirth

“…This research suggests that anywhere from 24% to 58% of TGE people want to have children, a broad range that illustrates the urgency of collecting better data and using such data to integrate the needs of TGE patients into provision of perinatal care services. 21 Importantly, racial and ethnic minorities, people living on low incomes, and people with disabilities are underrepresented in the existing literature, so the ability to draw conclusions is limited by small sample sizes that do not reflect the full diversity of the TGE population. 22 Rather than summarize the research literature on TGE childbearing as a whole, this section will highlight key findings against the backdrop of three interconnected themes: (1) the diversity of TGE childbearing experiences; (2) the institutional and individual erasure of TGE people within perinatal health care; and (3) the harm caused by entrenched gender norms in the provision of childbirth-related care.…”

“…This research suggests that anywhere from 24% to 58% of TGE people want to have children, a broad range that illustrates the urgency of collecting better data and using such data to integrate the needs of TGE patients into provision of perinatal care services. 21 Importantly, racial and ethnic minorities, people living on low incomes, and people with disabilities are underrepresented in the existing literature, so the ability to draw conclusions is limited by small sample sizes that do not reflect the full diversity of the TGE population. 22…”

Imaging evaluation of lymphoma in pregnancy with review of clinical assessment and treatment options

“…This review also touches on the current considerations regarding birthing parent onco-fertility. To ensure that this review is supportive and inclusive of the transgender population, the term “birthing parent” will be used in place of “maternal” [ 19 ].…”