Mapping the scientific literature on obstetric and perinatal health among sexual and gender minoritized (SGM) childbearing people and their infants: a scoping review

Abstract

Background

Evidence suggests sexual and gender minoritized (SGM) childbearing individuals and their infants experience more adverse obstetric and perinatal outcomes compared to their cisgender, heterosexual counterparts. This study aimed to comprehensively map obstetric and perinatal physical health literature among SGM populations and their infants and identify knowledge gaps.

Methods

PubMed, Embase, CINAHL, and Web of Science Core Collection were systematically searched to identify published studies reporting obstetric and perinatal outcomes in SGM individuals or their infants. Study characteristics, sample characteristics, and outcome findings were systematically extracted and analyzed.

Results

Our search yielded 8,740 records; 55 studies (1981–2023) were included. Sexual orientation was measured by self-identification (72%), behavior (55%), and attraction (9%). Only one study captured all three dimensions. Inconsistent measures of sexual orientation and gender identity (SOGI) were common, and 68% conflated sex and gender. Most (85%) focused on sexual minorities, while 31% addressed gender minorities. Demographic measures employed varied widely and were inconsistent; 35% lacked race/ethnicity data, and 44% lacked socioeconomic data. Most studies (78%) examined outcomes among SGM individuals, primarily focusing on morbidity and pregnancy outcomes. Pregnancy termination was most frequently studied, while pregnancy and childbirth complications (e.g., gestational hypertension, postpartum hemorrhage) were rarely examined. Evidence of disparities were mixed. Infant outcomes were investigated in 60% of the studies, focusing on preterm birth and low birthweight. Disparities were noted among different sexual orientation and racial/ethnic groups. Qualitative insights highlighted how stigma and discriminatory care settings can lead to adverse pregnancy and birth outcomes.

Conclusions

Frequent conflation of sex and gender and a lack of standardized SOGI measures hinder the comparison and synthesis of existing evidence. Nuanced sociodemographic data should be collected to understand the implications of intersecting identities. Findings on perinatal health disparities were mixed, highlighting the need for standardized SOGI measures and comprehensive sociodemographic data. The impact of stigma and discriminatory care on adverse outcomes underscores the need for inclusive healthcare environments. Future research should address these gaps; research on SGM perinatal outcomes remains urgently lacking.

Trial registration

The review protocol was developed a priori in February 2023, registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/5DQV4) and published in BMJ Open (https://bmjopen.bmj.com/content/13/11/e075443).

Background

Sexual and gender minoritized (SGM) people represent a diverse population encompassing various sexual and gender identity groups, including those who identify as lesbian/gay, bisexual, asexual, transgender, queer, two-spirit, intersex, as well as individuals with same-sex/gender attraction or behavior. Over the last decade, the percentage of people identifying as SGM has grown to 7.2% [1], with a rising interest in exploring biological pathways to family formation within these communities [2].

Despite known risks faced by the SGM childbearing population and their infants during the perinatal period (defined as conception through 12 months after birth) [3,4,5,6], our understanding of perinatal health outcomes in these groups has been limited due to the historical absence of sexual orientation and gender identity (SOGI) data collection in medical records and population-based surveys [7,8,9]. This limitation has hindered scholars’ ability to comprehensively study obstetrical and perinatal health outcomes among SGM individuals [10,11,12].

Existing research surrounding this topic has primarily focused on preconception health and pregnancy-related health behaviors among sexual minoritized individuals, with limited investigation into physical health outcomes during the perinatal period [10,11,12]. While scant but emerging research documents disparities in adverse perinatal outcomes between cisgender sexual minority women and cisgender heterosexual women, there is less understanding of these outcomes in gender minoritized/transgender and gender diverse (TGD) populations. Furthermore, the impact of intersecting identities and systems of oppression on perinatal outcomes remains poorly explored, despite documented evidence that individuals with multiple minoritized identities are disproportionately impacted by structural determinants of health that drive inequities [13,14,15].

Recent efforts to improve SOGI data collection have allowed for better documentation of perinatal health [16], with preliminary evidence revealing striking disparities in health outcomes among SGM childbearing individuals, including hypertension, miscarriage, preterm birth, delivery outcomes, postpartum hemorrhage, severe morbidity, and low birthweight infants [17,18,19,20,21,22]. Yet, perinatal care guidelines and interventions to address these disparities are lagging behind [23, 24], necessitating a comprehensive mapping and synthesis of existing evidence.

Prior reviews on the health of SGM perinatal populations have primarily assessed perinatal mental health [11], gynecologic health [25], and perinatal healthcare experiences [10, 25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. Many of these reviews do not follow PRISMA or other rigorous review guidelines. This scoping review aims to comprehensively map current knowledge and research gaps regarding the physical health outcomes of SGM childbearing individuals and their infants to enhance our understanding of obstetric and perinatal health disparities among these populations and guide next steps to improve health outcomes.

Methods

This scoping review adheres to the latest Joanna Briggs Institute (JBI) methodology for scoping reviews (2020) and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines and checklist (Appendix S1) [40, 41]. The review question, inclusion/exclusion criteria, and protocol were developed through a team-based, iterative process using the Population-Concept-Context (PCC) framework [40]. All components of this protocol were developed a priori, registered on Open Science Framework prior to conducting our search, and published in BMJ Open [42, 43]. Therefore, we provide a summary of the protocol here.

Eligibility criteria

Populations

Literature that includes at least one of the two populations will be included in this study: (1) SGM childbearing people, and/or (2) their infant(s).

Sexual minoritized population refers to individuals whose sexual orientation differs from the dominant societal “norm”, which typically centers around heterosexuality. Sexual orientation (SO) encompasses an individual’s patterns of sexual, emotional, and/or romantic attraction, and can be assessed through three dimensions: self-identification, behavior, and attraction. These dimensions—self-identification, sexual behavior, and sexual attraction—may not always align. For example, an individual who self-identifies as heterosexual might still report same-sex attraction or engage in same-sex behavior. Such individuals should be recognized as part of the sexual minoritized population to prevent misclassification and to accurately capture the outcomes and experiences of all minoritized groups.

Gender minoritized population or transgender and gender diverse (TGD) population are a group of individuals whose gender identity, expression, roles, or behaviors differ from the sex they were assigned at birth. This includes, but is not limited to, transgender, transmasculine, nonbinary, genderqueer, gender diverse, gender expansive, agender, and genderfluid individuals.

While terminology in this field is continually evolving, we define SGM population to include the various sexual and gender minoritized groups described above.

Studies focusing exclusively on intersex populations are excluded from our study, as their childbearing experiences are distinct from other SGM populations and merit a separate, focused investigation.

Concept

Studies that reported any obstetrical or perinatal-related physical health outcomes among SGM childbearing people and/or their infant(s) were eligible for inclusion. Specifically, we included obstetrical and perinatal physical health outcomes from the time of conception up to 12 months after birth (i.e., the perinatal period). Studies that focused on health outcomes in the pre-conception period (fertility treatment outcomes, risk of unintended pregnancy, teen pregnancy) or beyond 12 months after birth (health outcomes related to parenting) were excluded, unless they presented disaggregated physical health outcome data specifically during pregnancy or the perinatal period. Prior reviews have detailed perinatal healthcare experiences of SGM populations; therefore, to avoid redundancy, studies describing care experiences without explicit physical health outcomes were excluded. However, studies detailing care experiences with explicit findings related to physical health outcomes were included. Detailed descriptions and definitions of outcomes are delineated in Appendix S3.

Context

No temporal or geographical limitations were placed on the search. All peer-reviewed, empirical research studies with quantitative, qualitative, or mixed-methods research designs were considered. Non-English publications were not considered, as our team has limited proficiency in other languages.

Search strategy

Relevant studies were identified by searching Medline/PubMed (National Library of Medicine, NCBI), Embase (Elsevier, embase.com), Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete, EBSCOhost), and Web of Science Core Collection (Clarivate) in March 2023. Controlled subject vocabulary terms (i.e., MeSH, Emtree, CINAHL Subject Headings) were included when available and appropriate. The search strategies were designed and carried out by a health sciences librarian (CM), based on discussions with the research team. The exact search strategies are provided in Appendix S2. Duplicate records were removed using EndNote (Clarivate, Philadelphia, PA) [44] and Deduklick software (Risklick, Bern, Switzerland) [45]. The remaining records were imported into Covidence, a systematic review managing software, for record management and screening [46]. Additional duplicate records were then identified and removed either by Covidence or manually by team members, resulting in a final set of unique records for screening.

Screening

Six team members conducted three rounds of pilot testing on a random sample of 30 articles to ensure a high level of inter-rater reliability (κ ≥ 0.80) [47]. Once we reached 94% overall agreement (κ = 0.91), we started the screening process using Covidence. Two team members screened each record independently, and any disagreement that arose between reviewers at each stage was resolved through consensus-based team discussion.

Data extraction and management

We collaboratively created a standardized data extraction instrument adapted from JBI’s extraction sheet. In the initial extraction round, two team members independently charted data, and a third team member reviewed and resolved discrepancies using Covidence. Variables on the extraction sheet were modified iteratively based on preliminary synthesis and emerging themes from the data; additional data were then extracted and reviewed by different team members to form the finalized extractions.

Data Analysis and Presentation

We conducted a descriptive analysis of quantitative data to highlight trends of designs and population characteristics across the studies, along with synthesized findings. For qualitative data, we utilized NVivo, a qualitative data analysis software [48, 49], and employed an iterative hybrid approach to coding. This involved deductive coding using a pre-established list of codes collaboratively developed by the team, along with inductive codes to capture emerging outcomes [50, 51]. Examples of a priori codes include pregnancy complications, pregnancy-related hospitalizations, pregnancy termination, maternal death during delivery, and neonatal death. Following the completion of coding training, two coders independently coded the data. The coded excerpts had a 98.57% percent agreement rate, which were reviewed and validated by a third team member.

Data from studies that met inclusion criteria are presented in three separate tables: (1) study characteristics, (2) sample characteristics, and (3) study outcomes and key findings.

Results

Our systematic search retrieved 14,717 records, resulting in 8,740 unique references after duplicate removal. After abstract screening, 114 records remained for full-text review. Of these, 55 studies met eligibility criteria and were included in this review (see PRISMA flow chart in Fig. 1).

Fig. 1

PRISMA extension for scoping reviews (PRISMA-ScR) flow diagram of scoping review literature search for studies related to obstetric and perinatal physical outcomes among sexual and gender minoritized populations and/or their infants

Study characteristics

The included studies were from 10 countries; with two-thirds of the studies from North America (Canada, n = 5; US, n = 37); a quarter of the studies from Europe (Norway, n = 1; Spain, n = 4; Sweden, n = 3; the UK, n = 7; one study from across the European Union); three studies from Australia; and one study each from Africa (Kenya) and Asia (India). The studies were published between 1981 and 2023, with much of the literature having emerged in the last five years (66%, median in 2020).

The majority of the research designs were quantitative (n = 37, 67%), with fewer qualitative (n = 11, 20%) and mixed-methods studies (n = 7, 13%). Among the quantitative studies, most used cohort (n = 18) or cross-sectional (n = 17) study designs, with one case-control study and one combined cross-sectional and case-control study. Most qualitative studies did not explicitly specify a study design (n = 7), three used phenomenological methods, and one utilized an ethnographic approach. Study designs for mixed-methods studies were a combination of the methods described above.

The studies collectively involved 169,027 individuals, 815 couples, 73,706 pregnancies, 1,534,530 live births, and 201,873 newborns. Among these, 7.8% of individuals and 84.2% of couples were SGM, and 16.9% of pregnancies, 0.5% of live births, and 0.6% of newborns were associated with SGM individuals. Various sampling strategies were employed; non-probability convenience, purposive, and a combination of snowball and purposive were the most common. For more details, see Table 1.

Table 1 Characteristics of the included studies

Study Population characteristics

Various subgroups of the SGM population were captured in the included studies. A significant majority (n = 45, 85%) of the studies reported findings pertaining to sexual minoritized populations, while less than a third (n = 17, 31%) had findings related to gender minoritized populations.

Among the included studies that contained SO data, the majority (n = 34/47, 72%) employed self-identification as a measure of SO, over half (n = 26, 55%) considered sexual behavior/partnerships, and a few studies (n = 4, 9%) utilized attraction as a measure. However, most of the studies (70%) captured only one dimension of SO, less than a third (28%) used two measures, and notably, only one study included all three dimensions.

Apart from the inconsistent measuring of SO across studies, the categorization of these populations and the granularity of the data also varied significantly. Many studies dichotomized their samples into two groups—heterosexual and sexual minoritized individuals, and most studies limited their SO categorizations to heterosexual, lesbian, and bisexual groups. Few studies provided findings for other sexual minority groups, and outcome findings for queer, pansexual, and asexual individuals are notably missing.

While the majority of the existing SGM perinatal health literature had focused their investigations on sexual minoritized populations, scant but emerging publications have started exploring perinatal physical health outcomes among TGD individuals.

Similar to perinatal studies investigating sexual minoritized populations, the definitions and categories used to describe TGD individuals varied across the included literature. However, as most TGD-focused studies have been published in the last five years, more inclusive language and more nuanced gender minoritized subgroups were generally used. Most studies define TGD populations based on self-endorsed identities or labels, with some (n = 4/17) including gender expression-related labels, such as transmasculine, to identify TGD individuals.

However, it is important to note that many studies did not explicitly distinguish between gender and sex, and even when the differences were implied, terms were often conflated. Among studies with sex or gender data, over two-thirds (n = 26/38, 68.4%) may have conflated gender with sex; an example of such conflation includes labeling a sex variable (female, male, intersex) with binary gendered options like “Woman” and “Man”.

Most studies reported age, race/ethnicity, relationship status, and socioeconomic positioning. Of the studies that collected data on race (66%), few reported more than four racial categories, and most samples were predominantly white. Socioeconomic positioning was commonly operationalized with variables such as level of educational attainment, income, employment, social class, and insurance status. Less than half of the studies utilized a comparator population (e.g., a cisgender, heterosexual sample as a reference group), while more than half had focused investigations among SGM individuals or couples. Separately, one gender minority-focused study compared pregnancy and birth outcomes by testosterone use and not through sexual orientation or gender identity [52]. More details can be seen in Table 2 and Appendix S4.

Table 2 Study population characteristics

Study outcomes and key findings

Perinatal physical health outcomes of SGM childbearing individuals

The articles included in our final review examined various perinatal outcomes of SGM childbearing individuals and their infants. The majority (78%) included data on SGM childbearing individuals’ morbidity (or lack thereof); no study investigated obstetric and perinatal mortality among them (Table 3). Pregnancy termination/pregnancy loss were the most commonly examined outcomes, with few studies reporting pregnancy or childbirth complications. Among studies that did examine pregnancy and childbirth complications, gestational hypertension, ectopic pregnancy, and post-partum hospitalizations were the common outcomes assessed.

Table 3 Physical obstetric and perinatal outcomes of the included studies

Many quantitative studies provided documentation of the percentages or prevalence estimates of normal and adverse perinatal outcomes among the SGM populations without comparator populations (e.g., percentage of live births among SGM individuals, percentage or prevalence estimates of miscarriages/abortion, and pregnancy complications such as gestational hypertension). Among studies with cisgender heterosexual counterparts as reference groups, evidence of disparities was mixed. Some studies found no statistically significant differences in perinatal outcomes among SGM individuals when compared to the reference groups [20, 22, 53,54,55], some found SGM individuals to be at higher risk of having adverse perinatal outcomes [19, 54, 56,57,58], and others found heterosexual women to have higher rates or percentages of adverse outcomes [59, 60]. Limited studies explored risk of adverse outcomes among and between different SGM groups. One study found no statistical differences in prevalence of abortion among different sexual minority groups [61], and another found all sexual minority groups except lesbian women were more likely to have an abortion when compared to heterosexual women [62].

On the other hand, most qualitative data provided in-depth descriptions of the history of pregnancies, childbirths, their complications, and outcomes among SGM childbearing individuals and the broader contexts of which these had occurred [63,64,65,66,67,68,69]. These contexts frequently involved perceptions of discrimination, stigma, and cis-heteronormativity at structural, organizational, and interpersonal levels. Some studies further demonstrated how potential discrimination or differences in treatment and care might have led to adverse outcomes among participants. For instance, the reluctance of a care provider to examine a patient’s perineum postpartum, perceived to be related to stigma against their SGM status, resulted in a post-partum infection [70]. Other studies indicated that non-affirming environments contributed to delayed treatment and care, ultimately leading to adverse outcomes and complications [71,72,73,74].

Perinatal physical health outcomes of infants

While the majority (78%) of the existing literature examined physical health outcomes of the childbearing individuals, less (60%) investigated health outcomes of their infants. Still fewer articles examined infant outcomes other than live birth with no complications. The most examined adverse infant outcome was preterm birth, followed by low birthweight.

Among quantitative studies, many described the prevalence of infant birth outcomes without comparing them to a reference group. These included average gestational age at delivery among lesbian childbearing individuals [75], and the prevalence of live births [61, 76, 77]. Among the literature with findings on infant health outcomes, most compared infant outcomes among childbearing individuals of different SO groups and found infants of sexual minoritized women to be at higher risk of having adverse birth outcomes compared to infants of heterosexual women [19, 21, 78]. With a focus on intersectionality, three studies further disaggregated outcomes by SGM identities as well as by race/ethnicity. One study found that Black or Hispanic/Latinx/e/a sexual minoritized individuals have an increased risk of preterm birth compared to their heterosexual peers while white sexual minorities were found to have a decreased risk of preterm birth when compared to their heterosexual counterparts [13]. Two other studies did not find statistically significant differences in outcomes after adjusting for racialized groups [19, 79].

Only a handful of qualitative studies touched on infant outcomes. Existing data were largely confined to documentation of the childbearing individuals’ description of their infants’ hospitalizations, fetal demise, and birth-related infant outcomes. The most common examples of such descriptions include live births or receipt of neonatal intensive care [63, 64, 68, 69, 80]. Less common outcomes included descriptions of stillbirth, intrauterine growth restriction, and developmental disorders [69, 81].

For more details on the outcomes examined in the included studies, see Table 3.

Discussion

Main findings

Despite an increasing availability of SOGI data, the literature on obstetric and perinatal health outcomes for SGM childbearing individuals and their infants remains limited. Existing studies on SGM childbearing individuals predominantly focus on pregnancy termination or loss, neglecting common pregnancy complications (e.g., gestational hypertension, gestational diabetes, pre-eclampsia/eclampsia) and childbirth complications (e.g., postpartum hemorrhage). Moreover, no literature has examined perinatal mortality among SGM childbearing individuals.

For studies with infant birth outcomes, most of them only reported a single non-adverse outcome (e.g., live births) pertaining to this population. Studies exploring adverse birth outcomes for infants are notably underrepresented, and when reported, most focused on adverse weight at birth, which includes low weight at birth, extremely low birth weight, and large for gestational age. Literature on other measures of perinatal morbidity (e.g., low Apgar scores, birth defects) and fetal or infant mortality are notably absent. Investigations into a broader range of adverse physical outcomes for both childbearing individuals and their infants are critically needed.

In addition to a narrow scope of outcomes examined, the existing literature also lacks diversity in the populations that they sampled. This lack of diversity is reflected in multiple domains, including lack of diversity in the sampled populations’ sexual orientations, gender identities, race/ethnicity, socioeconomic positioning, and geographic locations.

Current research has predominantly focused on sexual minoritized individuals, leaving a significant gap in understanding the health outcomes of gender minoritized individuals. Among sexual orientation-focused studies, many dichotomized sexual orientation groups into heterosexual and non-heterosexual groups without presenting further disaggregated data. Even when disaggregated, participants are typically divided into a few sexual minority subgroups, primarily examining outcomes related to lesbian/gay or bisexual groups exclusively. There is a critical need for a more nuanced examination of additional SGM subgroups, including pansexual, queer, asexual, non-binary, and genderfluid individuals, as each subgroup presents its own distinct health risks, behaviors, and needs. Findings from other fields further substantiated that individuals from different SGM subgroups have differing health outcomes, including varied rates of anxiety, depression, substance use, cancer incidence, cardiovascular disease, and other chronic conditions [82,83,84,85,86,87]. Therefore, obstetric and perinatal research that provides insights specific to each subgroup of the SGM population is essential for informing tailored considerations and intervention strategies.

Additionally, the categorization of SO groups is further hindered by the often-unidimensional representations of sexual orientation measures available in data sources, typically limited to identity or behavior. This limitation is compounded by the absence of standardized data collection on sex at birth and gender, leading investigators to conflate the two and employ binary or inappropriately gendered language, which interferes with researchers’ ability to examine outcomes aggregately across groups.

The current limitations in data and data infrastructure outlined above have significantly hindered scholars’ ability to accurately assess perinatal health outcomes among SGM individuals. Rectifying these deficiencies requires a global increase in funding and support for SGM-related obstetric and perinatal health research. Data systems should prioritize the development of routine, comprehensive, and consistent collection of SOGI data across regional and national databases, as it is essential for meaningful comparisons and longitudinal analyses. Although there is no worldwide consensus on the best practices for SOGI data collection and measurement, current consensus in the United States endorses a two-step process to assess TGD-inclusive gender identity and comprehensive measurement of all three dimensions of sexual orientation (identity, attraction, behavior) [9, 88, 89]. Important to note, each measurement strategy has distinct advantages and inherent limitations to consider. Detailed or disaggregated reporting may facilitate nuanced understanding of the populations, but it may also increase privacy risks, respondent burden, and may limit the ability to detect meaningful differences in rare health outcomes due to lower statistical power. Consequently, while a broad range of inclusive and diverse options should be considered when assessing SOGI, this must be balanced with robust privacy safeguards to foster trust within the SGM community, and an iterative feedback approach should be taken to ensure the data collection process aligns with the community’s evolving needs and preferences.

Beyond the limitations posed by the lack of SOGI data, the generalizability of studies is further hampered by the insufficient collection of sociodemographic data. More than a third of the included studies did not incorporate race/ethnicity data, and even when included, these data often lack diversity, primarily representing non-Hispanic white populations. The limited collection of various socioeconomic data and the failure to recruit study participants from diverse socioeconomic backgrounds further impede nuanced analyses of perinatal health outcomes among SGM populations through an intersectional lens [15]. Future studies should prioritize recruitment efforts aimed at ensuring that samples reflect real-world population demographics and intentionally prioritize recruitment of sexual, gender, and racially/ethnically minoritized populations to better document experiences across various groups.

In addition to improving sampling techniques and strategic participant recruitments, enhancing the robustness of research methodology is crucially needed, especially for qualitative and mixed-methods studies. Many of these studies provide minimal descriptions of the study design and methods employed––often only noting ‘semi-structured, in-depth interviews were conducted’––and frequently lack an explicit identification of the theoretical framework underpinning the research. A checklist, such as COnsolidated criteria for REporting Qualitative research(COREQ), could be used to improve the rigor in collecting and reporting of qualitative data [90, 91].

Finally, our comprehensive mapping of published scientific literature highlights a global shortage of research on this topic. The studies included in this review are predominantly concentrated in North America and Europe, limiting the generalizability of their findings to diverse geopolitical and health infrastructure contexts, particularly in Asia, South America, and Africa. Agenor et al. (2021) also identified a lack of reproductive health data among SGM individuals from these regions [25]. Within the US, additional factors such as urban-rural divides and varying state-level policies further influence health outcomes, particularly obstetric and reproductive health outcomes [18, 92, 93]. Reporting that delves into these regional and contextual differences is crucial for a more complete understanding of the inequities present within the US. While it is crucial to conduct investigations on obstetrical and perinatal health among SGM populations globally to fill knowledge gaps and inform policy, hostile social climates and legal policies in certain areas may render research impossible or unsafe for potential participants. The complex interplay between the legality and public acceptance of SGM individuals in certain regions poses notable challenges to rigorous investigation of SGM-related obstetric and perinatal health outcomes. Nevertheless, the pursuit of high-quality research in this domain remains imperative and inherently valuable, particularly in areas where investigations can be conducted safely. An increase in research funding to support investigations in this area and the training of researchers conducting these investigations is needed to achieve this goal.

While the challenges are evident, it is equally important to highlight the encouraging progress being made in this field. The number of investigations has grown exponentially, with most of the literature being published in the last five years. The National Institutes of Health has officially recognized SGM populations as a health disparities group in 2016, leading to increased resources and funding dedicated to eliminating health disparities among these populations [94]. We have also seen a rise in funding opportunities, structural support, and awareness of the necessity to train researchers dedicated to SGM health disparities research. Moreover, more guidelines and recommendations are being released by governmental agencies and research organizations to advocate for the implementation of more comprehensive and standardized SOGI measurements at both regional and national levels [16, 95, 96]. Another positive observation is that slightly more than half of the studies conducted in this review centered at the margins by focusing investigations among SGM populations, while the remaining studies utilized comparator populations to document inequities. While comparison to culturally dominant groups is crucial for documenting and eventually reducing inequities, the approach of centering at the margins moves away from the notion that these dominant groups represent the norm and fosters greater diversity in research studies [15, 97].

Strengths and limitations

This study is not without limitations. By excluding non-English works, grey literature, and literature in alternative formats (e.g., book chapters, reports), there is a risk of missing valuable insights from non-Eurocentric nations and non-peer-reviewed sources. Additionally, the study’s cut-off in 2023 may omit the latest publications.

While acknowledging its limitations, this study is the first systematic scoping review to comprehensively map the evidence base in this expanding field using rigorous methodologies; including a priori publication and registration of protocol, adherence to JBI manual and PRISMA-ScR guidelines, and a high Kappa score indicating strong concordance in screening and analysis decisions within the team. Additionally, this review’s inclusion/exclusion criteria were intentionally broad to capture all relevant findings in the field, including outcomes from descriptive to association and comparative studies. Through our systematic search and analyses, we offer valuable insights and direction for future research endeavors.

Conclusions

This scoping review highlights crucial avenues for advancing research on pregnancy and childbirth outcomes among SGM individuals. Existing SGM perinatal research primarily focuses on sexual minoritized women’s pregnancy termination; data on pregnancy complications and adverse birth outcomes are sparse. Studies to date are largely Ameri- and Eurocentric, and predominantly feature white individuals, reflecting a notable gap. Challenges such as the conflation of sex and gender, coupled with inconsistent and limited availability of SOGI measures, hinder the comparison and synthesis of existing evidence in this domain. More detailed sociodemographic data must be incorporated to better capture intersecting identities and their health implications. The scope of the investigated perinatal health outcomes should expand. Research on SGM pregnancy- and birth-related outcomes remains urgently lacking.