Legacies and Futures
Research type
Research Study
Full title
Legacies and Futures: Gestational Parents' Experiences with Vulnerability and Resilience as it Influences Parent and Neonatal Health
IRAS ID
264198
Contact name
Kate Luxion
Contact email
Sponsor organisation
University College London
Clinicaltrials.gov Identifier
Z6364106/2020/02/50, UCL Data Protection Number
Duration of Study in the UK
2 years, 7 months, 1 days
Research summary
Summary of Research
Patients using reproductive health services, like pregnancy/antenatal care, are often assumed to be heterosexual married women whose gender matches their sex assigned at birth (i.e., cisgender). This assumption shapes pregnancy care, giving a limited picture of pregnancy and childbirth. In these instances, parents who are lesbian, gay, bisexual, queer, intersex, asexual, and/or transgender (LGBTQIA+) can feel invisible or out-of-place because of stigma. In the United Kingdom, there are 525,000 LGBTQIA+ potential gestational parents who may face this type of discrimination while receiving pregnancy care. For this study, discrimination and prejudice, as forms of minority stress, will be assessed along with resilience factors to better understand the impacts on pregnancy and childbirth. The planned study will observe pregnant parents to see how risk and resilience in pregnancy care might influence parent health and birth outcomes. A sample of pregnant parents (N=800) will take part through an online panel survey (completed twice), linked to their electronic health records for biomarker data. LGBTQIA+ pregnant parents (n=200) will be case-matched to Cisgender, heterosexual pregnant parents (n=600) using a 3 to 1 ratio. Patients from University College London Hospital, one of four sites, will be invited to a sub-study where they will asked to complete an at-home journal activity in-between their two online surveys. This subsample (n=30) will have a mixture of high and low vulnerability and resilience scores to reduce homogeneity (i.e. sameness) in the scores. Online panel surveys and the journal responses combine as part of a concurrent mixed-methods longitudinal study. Findings could improve pregnancy care guidelines and policy to assist in reducing minority stress for pregnant parents.Summary of Results
People who are marginalised based on their sexual orientation and/or gender (e.g., LGBTQIA+ individuals) often face negative experiences while building a family through pregnancy. However, the extent of these experiences within the NHS remains poorly understood due to lack of inclusive data monitoring. Conceptually, negative experiences are linked to additional stresses (i.e., minority stress) that can in turn result in preventable vulnerabilities. Research and interventions have suggested that forms of resilience, as dynamic resources, might be able to offset the impacts of minority stress and negative experiences. The Legacies and Futures study used survey and patient data to assess both if there were differences in outcomes for LGBTQIA+ families, both for gestational parent health and neonatal outcomes, as well as considering vulnerability sources and resilience resources (i.e., re/sources) side-by-side in the process. The sample for the study included both LGBTQIA+ gestational parents (141 participants) and cisheterosexual peers (414 participants) receiving pregnancy care. Findings from the study showed that re/sources are associated with the probability of gestational parent health, specifically maladaptive coping (as harmful) and emotional regulation (as protective). For the neonatal outcomes, there was only one group-based difference, showing that LGBTQIA+ individuals within the sample had a higher probability of non-ideal birth weights. This disparity shows differences that would impact clinical care and signal more need to safeguard neonatal health. While there were no other differences between the groups in the sample, there were findings that showed that neonatal health at birth (i.e., Apgar score) is associated with gestational parents’ emotional regulation, household vulnerability, level of outness, and perceived social support. The Apgar score findings show a direct connection between parental re/sources and/or experiences during pregnancy to their neonates’ outcomes. A journal activity was completed by a smaller group from the sample. This data was integrated with the patient data and survey results to better understand the process of meaning-making from conception through the first month postpartum and the role of vulnerability sources and re/sources within this. Findings highlighted the need for in-clinic support that can help improve perinatal outcomes for gestational parents. Overall, the findings point to the need for inclusive data monitoring for gender and sexual orientation to better understand service deployment and underpin the ability to conduct future research.REC name
London - Central Research Ethics Committee
REC reference
21/LO/0551
Date of REC Opinion
10 Sep 2021
REC opinion
Further Information Favourable Opinion