Stanford Research Uncovers Health Risks for Mothers Giving Birth in Two-Mom Families

When Stanford Medicine Children’s Health obstetrician/gynecologist Juno Obedin-Maliver, MD, had a baby in 2017, she and her partner received pushback on listing both of their names on their child’s birth certificate despite having the legal right to do so.

The experience motivated Obedin-Maliver, an expert in the health of LGBTQ+ people, to study the vulnerabilities and needs of people like her.

“I thought, ‘How many other households in California have two women raising a kid, or a transgender man giving birth with woman or man partner?’ It turns out nobody had those data,” said Obedin-Maliver. “That was the initial impetus for this study, wondering how many folks are like my family, what does it look like across the state, and are there health differences for people in those groups during pregnancy and birth?”

She and her colleagues recently published a study outlining several pregnancy and birth risks for mothers in two-mom families. Certain complications, including serious conditions such as postpartum hemorrhage, were substantially more common in these mothers, they found.

Here are the study’s top takeaways:

New California birth certificates enabled the research

California’s birth certificates were changed in 2016 to make them more inclusive. They now ask for “parent giving birth” and “parent not giving birth;” each role can be further specified as “mother,” “father” or “parent.” The state’s birth certificate data is linked to electronic medical records, enabling researchers to learn about California’s diverse populations of newborns and parents.

The study, of California births between 2016 and 2019, included 1.4 million mothers who gave birth with father partners; about 2,500 mothers with mother partners; and about 500 fathers giving birth with any partner. The research is the first large, population-based study to investigate pregnancy and birth outcomes in sexual and gender minorities in the U.S.

“There’s a diversity of parent structures among people building their families in California, and that was a really fundamental thing that hadn’t been shown before,” Obedin-Maliver said.

Certain risks higher in two-mom families

Women in two-mom families, who may identify as lesbians, are exposed to daily stress from living in a world that doesn’t see and consider them, Obedin-Maliver said. Prior research has shown a variety of health risks for non-pregnant LGBTQ+ women, such as higher blood pressure, cancer, skin disorders, asthma, diabetes and heart disease. Some of these conditions – including high blood pressure or diabetes – can make pregnancy and birth riskier.

Mothers with mother partners did have higher rates of certain pregnancy complications that may have been explained by poor health before pregnancy. For example, they were more likely to have preeclampsia, which is linked to high blood pressure.

But after controlling statistically for the effects of pre-pregnancy health differences, there were still gaps in birth complications between mothers in two-mom families and those who had father partners. Postpartum hemorrhage and severe childbirth complications were more common, for example. Although there’s no clear explanation for that gap, it suggests that doctors could do more to promote the health and safety of sexual and gender minority patients as they give birth.

Many more twins

Perhaps because they often became pregnant via assisted reproductive technology, mothers with mom partners were about four times as likely to have twins or other multiples as those with father partners. Twin pregnancies are inherently riskier for the mother and the babies, and encouraging singleton pregnancies for all patients seeking assisted reproduction with techniques such as IVF could help lower risks, Obedin-Maliver said.

Doctors can advocate for patients …

Obstetricians need to be aware of the specific medical risks faced by people in two-mom families, so that they know, for instance, to carefully monitor blood pressure and screen early for signs of preeclampsia.

There’s also room for all services for pregnant and birthing people to become more inclusive – everything from making childbirth classes explicitly welcoming of all parents, to expanding who can be on birth certificates in other states across the country.

“Everything is very ‘Mommy-Daddy,’ and it excludes people,” said Stephanie Leonard, PhD, a Stanford Medicine epidemiologist who helped lead the new research. “There’s a lot that can be done in the clinical care environment to make it more welcoming for people who are not in a mother-father relationship.”

… and patients can advocate for themselves

“For patients, I would recommend really advocating and asking questions to learn to what extent your provider knows about these disparities,” said Obedin-Maliver. “I would ask your doctor, ‘Have you seen these data? Are you thinking about and taking care of LGBTQ+ people in your practice? How is your hospital at dealing with postpartum complications or emergencies?’”

Many more young adults identify as members of sexual and gender minority groups than in the past, and they are increasingly likely to decide to build families by giving birth, the researchers said, noting that this means there is a growing need to identify how to provide the best medical care for all people going through pregnancy and birth. “Our goal is not just to prevent severe birth outcomes,” Leonard said. “It’s also to promote positive experiences with pregnancy and childbirth for all families.”

_{Also featured in the San Francisco Chronicle}