5 - (SYM 119) The Impact of Sexual Assault Severity on Pregnancy Outcomes Among Sexual Minority Women

Abstract Body
Sexual minority women (SMW) are at increased risk for sexual victimization and trauma exposure broadly. As a result of that, SMW are at an elevated risk of negative psychiatric outcomes, such as trauma, PTSD, and depression. There is a literature, albeit fairly scant, that trauma exposure may have negative impacts on pregnancy, likely related to elevated cortisol and barriers to getting care (e.g., avoiding prenatal care).
Despite the elevated risk of sexual assault among SGM women, there is a lack of research around how this impacts pregnancy and reproductive decision making. Resulting in a a critical need to examine how prior trauma can impact pregnancy and reproductive decision making for sexual minority women.
Our data set includes lesbian and bisexual cisgender women. After a secondary data analysis of a longitudinal study, we found that lifetime adult sexual assault (SA) severity at baseline was associated with a higher likelihood of having ever been pregnant, having a miscarriage, or having an abortion. Only one of these associations was moderated by sexual orientation, with SA severity predicting a higher likelihood of miscarriage only for lesbians. The association was not significant for bisexuals. Furthermore, attributing at least one experience of sexual assault to one's sexual orientation was associated with an increased likelihood of ever having had a miscarriage, but it was not associated with abortion or pregnancy. Regardless of sexual orientation, a more severe sexual assault history was associated with a higher likelihood of subsequent pregnancy but did not predict subsequent miscarriage or abortion.  Attributing at least one of these sexual assault experiences to one's sexual orientation continued to predict an increased likelihood of having a subsequent miscarriage but did not predict pregnancy or abortion.
Previously, much of the literature has focused on associations between sexual assault and psychiatric outcomes, while focusing less on downstream effects of sexual assault on physical health and the impact on reproduction. Previous studies (Flentje, 2020; Hatzenbuehler et al., 2014) have discussed the impact of minority stress and physical (e.g., cardiovascular) health, and our findings are consistent with the theory that minority stress can impact physical health outcomes. The results of these analyses are important, as they highlight an association between severity of sexual assault and pregnancy outcomes among sexual minority women, who have been understudied to date.