Is Transgender Pregnancy Different from Cisgender Pregnancy?
Study sheds insight into differences between transgender and cisgender pregnancy outcomes in the United States
By: Vann Jones
Great news! There’s a new study on transgender pregnancy!
This May, researchers out of Michigan released a study analyzing nearly 2,000 transgender pregnancies, comparing them to cisgender pregnancies to identify differences between the two groups!
TL;DR: The transgender patients studied were more likely to have chronic conditions and had lower rates of births by cesarean than their cisgender counterparts. No differences were found in rates of preterm delivery or severe parental morbidity.
The study analyzed pregnancy outcomes of 256 trans people and 1,255,942 cisgender people in the Medicaid database as well as 1,651 trans people and 1,465,565 cisgender people in the commercial database, making it one of the largest studies of transgender people who have given birth to date. This is extremely exciting for transgender pregnancy nerds (such as myself) who are used to working with case studies and data from samples of less than a hundred people.
Before we get too into the details and findings of this study, let’s talk about the setbacks. No dataset is perfect, and it’s important to be open about the limitations that come with all research.
While data on race and ethnicity was captured by Medicaid, the commercial insurance did not provide such details, and so it is difficult to draw sound relationships in the data based on these factors.
Despite the large sample size when put in comparison to other studies, the study is still not large enough to be representative of the population as a whole. This means that it may not be able to accurately detect a difference in the rate of severe parental mortality, an already rare occurrence.
Data on testosterone usage could not be gathered, and so it is impossible to make any connections from this data alone on the effects of testosterone on pregnancy outcomes.
There is always the possibility of under-capture in claims data, meaning that there are many transgender birthing parents who may have not shared their gender identity or a chronic condition with their provider.
Now let’s jump into the findings! Intriguingly, it was found that while transgender parents had higher prevalence of chronic conditions, notably anxiety or depression, the rates of chronic conditions were lower than that reported by the general transgender population of the United States. As mentioned above, this could be a result of poor data capture, but it could also suggest differences between birthing and non-birthing trans people.
The study also found that in both datasets, transgender parents had lower rates of cesarean sections than their cisgender counterparts. The authors of the study suggest that this difference in rates may have resulted from differences in care providers or interventions, but it’s interesting to note that transgender people had fewer cesarean sections than cisgender parents despite having higher rates of chronic conditions. The authors consider that higher-risk subpopulations of trans birthing parents may have been missed and that this could account for the lower rates, but it’s impossible to say with certainty what has led to this statistical difference.
Of the findings made by this study, the most interesting are those surrounding preterm delivery and pregnancy-related mortality. Both datasets found very similar rates between transgender and cisgender preterm delivery. In terms of morbidity, the Medicaid database could not produce a comparison due to its low sample numbers, however, the commercial database found similar rates of severe parental mortality between the two populations. This is rather promising, as it shows that transgender identity might not directly link to negative pregnancy outcomes, but this finding creates further questions and points to the need for additional research to understand these outcomes better.
It is a well known fact that the United States has the highest pregnancy-related mortality rate of any developed country, with Black and Indigenous Americans facing rates much higher than their white counterparts. Additionally, Black and Indigenous Americans face much higher rates of preterm delivery, which many have suggested could be caused by minority-induced stress caused by living within a racialized society.
Curiously enough, the Medicaid data, while notedly based on a smaller sample size than the commercial data, found that transgender birthing parents were less likely to be white than their cisgender counterparts. This raises the question: why weren’t the rates of preterm delivery shifted to reflect this change in population demographics? It’s most likely due to a small sample size, however, this study stresses the need to continue funding research to better understand the challenges and needs of the Black Indigenous People of Color (BIPOC) transgender population living in the United States in order to better serve and support them.
