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2026 SOAP Annual Meeting
April 29 - May 3, 2026 | Montreal, Quebec Canada
2340643
Severe Maternal Morbidity and Comorbidity Burden Among Transgender and Gender Nonconforming Birthing Patients
Poster Presenter
Part of Topic
Recovery: Morbidity, Depression
Severe Maternal Morbidity and Comorbidity Burden Among Transgender and Gender Nonconforming Birthing Patients
Jil Decker, MD, Jeanette Bauchat, MD, Jerome Federspiel, MD, PhD, Matthew Fuller, MS, Ashraf Habib, MMBCh, MSc, MHSc, Holly Ende, MD, Marie-Louise Meng, MD
Society for Obstetric Anesthesia and Perinatology Annual Meeting
4/30/2026
Background & Hypothesis
•Transgender and gender nonconforming (TGNC) patients are a vulnerable subset of the obstetric population
•TGNC is associated with ↑ risk for sexually transmitted infections, mental health distress, and substance use disorders, which may confer ↑ pregnancy risk1
•Pregnancy-related health risks among TGNC patients remain poorly defined
•Studies are mixed, with some demonstrating no increased maternal morbidity and others highlighting disparities in patient-reported outcomes, postpartum mental health, and access to appropriate care2,3,4,5,6.
•We sought to describe comorbidities and maternal morbidity outcomes among TGNC birthing patients. We hypothesized that TGNC patients have higher prevalence of cardiovascular disease (CVD) risk factors and maternal morbidity.
Study Design & Methods
•Retrospective cohort
•Premier Healthcare Database (2016–2020)
•TGNC identified via ICD codes and medication administrations
•Primary outcome: rate of severe maternal morbidity (SMM) and non-transfusion SMM among TGNC versus non-TGNC birthing patients
•Multivariable logistic regression models estimated associations between TGNC status and outcomes
•Adjusted for age, payor status, and obstetric comorbidity index
Results
•661 TGNC, 4,789,012 non-TGNC
•TGNC patients had higher prevalences of:
-gestational diabetes (9.8% vs. 8.0%)
-pre-existing diabetes (3.6% vs. 1.5%)
-asthma (8.2% vs. 5.0%)
-chronic hypertension (3.8% vs. 3.4%)
-substance use disorder (9.2% vs. 6.4%)
-mental health disorders (17.9% vs. 7.1%)
•Rates of SMM and non-transfusion SMM were higher among TGNC patients, but not significantly so
Conclusion & Discussion
•We developed a computable phenotype to identify TGNC birthing patients using structured administrative data1,2
•Adjusted differences in SMM were not statistically significant
•TGNC birthing patients exhibited higher rates of cardiovascular and mental health comorbidities, established contributors to adverse perinatal outcomes.
•As one of the largest studies of TGNC obstetric patients, we demonstrated elevated chronic disease burden in these patients prior to and persisting into pregnancy.
•Future research should examine mechanisms for this increased cardiometabolic risk, including gender-affirming hormone use, chronic stress, and barriers to accessing gender-affirming care, to seek interventions to improve perinatal and healthcare equity.