Characteristics of Births Conceived Through Medically Assisted Reproduction by Parental Structure in Louisiana (2016-2023).

Objective: To examine the risk of pregnancy complications and adverse delivery outcomes among births conceived using medically assisted reproduction (MAR) in same-sex, different-sex, and single-parent households. Methods: We conducted a cross-sectional population-based analysis of all MAR births in Louisiana from 2016 to 2023. Based on the sex of both parents listed on the child's birth certificate, we classified births as occurring in different-sex (reference category), same-sex, and single-parent households. We used modified Poisson regression with robust standard errors to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CIs) for all study outcomes including gestational diabetes mellitus (GDM), gestational hypertension (gHTN), induced labor, cesarean delivery, breech delivery, preterm birth, and low birth weight. Results: Among 2,934 MAR-conceived births, 177 (6.0%) were in same-sex relationships, 93 (3.2%) were in single-parent households, and 2,664 (90.8%) were in different-sex relationships. After adjusting for sociodemographic, preexisting health, and pregnancy risk factors, birthing people in same-sex relationships experienced higher risks of labor induction (aRR: 1.23; 95% CI: 1.06, 1.43) and lower risks of cesarean delivery (aRR: 0.89; 95% CI: 0.81, 0.98) compared to those in different-sex relationships. Single-parent households exhibited higher risks of gHTN (aRR: 1.56; 95% CI: 1.10, 2.21). Conclusions: Birthing people in same-sex relationships were at higher risk for labor induction and lower risk of cesarean delivery, while single parents were at greater risk for gHTN. These findings underscore the importance of considering family structure in research and clinical care to address disparities in reproductive health.