Transgender people show similar pregnancy outcomes to cisgender people

Transgender, nonbinary and gender diverse people experience worse health outcomes compared to cisgender individuals.

“Some transgender men retain their uterus and give birth, but little research has focused on pregnancy outcomes for this group,” said Daphna Stroumsa, M.D., M.P.H., assistant professor of obstetrics and gynecology at Michigan Medicine.

The findings

Despite overall worse health outcomes in the transgender population, a Michigan Medicine-led study found that transgender individuals show similar rates of severe parental morbidity and preterm birth and lower rates of cesarean delivery when compared to cisgender people.

The results are published in JAMA.

The study includes data from individuals who gave birth between 2014 and 2018 drawn from a commercial data base (1,465,565 cisgender and 256 trans people) and the Medicaid data base (1,255,942 cisgender people and 1,651 trans people.)

The researchers adjusted the data for differences in age, race and ethnicity (for the Medicaid database), chronic conditions and prenatal conditions when assessing the association between trans identification and pregnancy outcomes.

Interpreting unexpected results

The results were unexpected as the prevalence of chronic conditions in trans people in this study was lower than those reported for the general trans population.

“This could highlight a difference between birthing and non-birthing trans people or simply be a result of our study design,” said Erica Marsh, M.D., professor of obstetrics and gynecology and chief of the Division of Reproductive Endocrinology and Infertility at U-M Von Voigtlander Women’s Hospital.

The researchers stated they could have missed higher risk subpopulations of trans people giving birth who had not identified as trans to their clinician.

The small sample size of trans people also makes it difficult to detect rare outcomes like severe parental morbidity.

Next steps

Although claims data sets are helpful for broad comparisons between populations, the research team hopes to conduct more fine-grained studies to better characterize birth outcomes for transgender parents.

“Prenatal care access barriers, minority stress and stigma due to transphobia, and prior or ongoing use of testosterone may still place trans people at heightened risk of pregnancy complications,” Stroumsa said.

“Studies that evaluate patient-reported outcomes and collect data from individuals over time will improve the quality of care for transgender parents and the overall health of this underserved population,” concluded Marsh.

In addition to Stroumsa and Marsh, the Michigan Medicine research team includes Michelle Moniz, M.D., M.Sc.; Halley Crissman, M.D., M.P.H.; Vanessa Dalton, M.D., M.P.H.; Anca Tilea, M.P.H., and Paul Pfeiffer, M.D., M.Sc.

Paper cited: “Pregnancy Outcomes in a US Cohort of Transgender People,” Journal of the American Medical Association. DOI: 10.1001/jama.2023.7688