Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey

Abstract

Background: Transgender, nonbinary, and gender-expansive (TGE) people experience pregnancy. Quantitative data about pregnancy intentions and outcomes of TGE people are needed to identify patterns in pregnancy intentions and outcomes and to inform clinicians how best to provide gender-affirming and competent pregnancy care. Aims: We sought to collect data on pregnancy intentions and outcomes among TGE people assigned female or intersex at birth in the United States. Methods: Collaboratively with a study-specific community advisory team, we designed a customizable, online survey to measure sexual and reproductive health experiences among TGE people. Eligible participants included survey respondents who identified as a man or within the umbrella of transgender, nonbinary, or gender-expansive identities; were 18 years or older; able to complete an electronic survey in English; lived in the United States; and were assigned female or intersex at birth. Participants were recruited through The PRIDE Study – a national, online, longitudinal cohort study of sexual and gender minority people – and externally via online social media postings, TGE community e-mail distribution lists, in-person TGE community events, and academic and community conferences. We conducted descriptive analyses of pregnancy-related outcomes and report frequencies overall and by racial and ethnic identity, pregnancy intention, or testosterone use. Results: Out of 1,694 eligible TGE respondents who provided reproductive history data, 210 (12%) had been pregnant. Of these, 115 (55%) had one prior pregnancy, 47 (22%) had two prior pregnancies, and 48 (23%) had three or more prior pregnancies. Of the 433 pregnancies, 169 (39%) resulted in live birth, 142 (33%) miscarried, 92 (21%) ended in abortion, two (0.5%) ended in stillbirth, two (0.5%) had an ectopic pregnancy, and seven (2%) were still pregnant; nineteen pregnancies (4%) had an unknown outcome. Among live births, 39 (23%) were delivered via cesarean section. Across all pregnancies, 233 (54%) were unintended. Fifteen pregnancies occurred after initiation of testosterone, and four pregnancies occurred while taking testosterone. Among all participants, 186 (11%) wanted a future pregnancy, and 275 (16%) were unsure; 182 (11%) felt “at risk” for an unintended pregnancy. Discussion: TGE people in the United States plan for pregnancy, experience pregnancy (intended and unintended) and all pregnancy outcomes, and are engaged in family building. Sexual and reproductive health clinicians and counselors should avoid assumptions about pregnancy capacity or intentions based on a patient’s presumed or stated gender or engagement with gender-affirming hormone therapy.

Changes in the Sexual Behavior of Partners in Each Trimester of Pregnancy in Otwock in Polish Couples

“…Of course, it should be remembered that not just heterosexual people, or people whose psychological gender is the same as their biological sex, can plan to be and be pregnant. People who do not identify as women, or who are trans, nonbinary or otherwise gender diverse can also be pregnant [ 24 , 25 , 26 ].…”

Early Fetal Growth Restriction of Both Twins in a Transgender Man

“…Although patients with previous use of GAHT underwent more cesarean deliveries compared to those without the prior intake of GAHT (36% [9/25] versus 19% [3/16], respectively), the difference was not statistically significant [ 10 ]. A subsequent cross-sectional study based on a quantitative survey is in line with the finding that only a minority (23%) of transgender individuals deliver by cesarean section, although prior GAHT is not taken into account [ 11 ]. Both studies lack the comparison of pregnancy outcomes between singleton and multiple pregnancies, as well as between spontaneously conceived gestations and those obtained through assisted reproductive techniques.…”

Gender-inclusive writing for epidemiological research on pregnancy

“…This includes transgender, non-binary and gender-diverse people who do not have a gender identity and gender modality (see box 1) congruent with their assigned sex at birth 2. A recent study of gender-diverse people assigned female or intersex at birth found that 12% had been pregnant and 11% desired future pregnancies 3. With younger generations being more likely to openly identify as Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Two-Spirit, or other sexually- and gender-diverse identities (LGBTQIA2+),4 5 the proportion of pregnant people who do not identify as cisgender women can be expected to increase.…”