LAUSR

Background: Black women and sexual minority women are more likely to report adverse maternal health. Little research has investigated maternal health disparities at the intersection of race/ethnicity and sexual orientation or the mechanisms that contribute to these disparities. Materials and Methods: We analyzed data from the National Longitudinal Study of Adolescent to Adult Health. Our sample was restricted to Black and White women who had at least one live birth and were followed-up in Wave V of the data (n = 3,396). We used multivariable logistic regression to analyze the associations between race, sexual orientation identity, and a four-item state-level index of sexual orientation-related nondiscrimination laws. Results: We found that higher numbers of state-level sexual orientation-related nondiscrimination laws were associated with lower risk of maternal hypertension among U.S. women overall (odds ratio [OR] = 0.82, 95% confidence interval [CI] 0.73-0.93), and Black women had a higher risk of maternal hypertension relative to White women (OR = 1.32, 95% CI 1.00-1.79). Interactions between race, sexual orientation identity, and sexual orientation-related policies show that, regardless of sexual orientation identity, sexual orientation-related nondiscrimination laws were associated with a lower risk of maternal hypertension among White mothers (OR = 0.80, 95% CI 0.70-0.92). However, among Black women, these laws were associated with a lower risk of maternal hypertension among lesbian and bisexual women (OR = 0.18, 95% CI 0.05-0.68) only. Conclusions: Laws that prevent discrimination related to sexual orientation in various societal domains may play an important role in improving maternal health outcomes among White women in general and Black lesbian and bisexual women in particular.