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Transmasculine pregnancy-Occurrence, associations, and outcomes: A quantitative systematic review
Catherine Meads1, Chelsea Daniels2, Shawn Walker3
1Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK.
Introduction:
Transmasculine people experience incongruence between their gender identity and sex (registered female at birth, AFAB). Little is known about transmasculine pregnancy. This project systematically reviews all published quantitative evidence on transmasculine pregnancy occurrence, associations, and outcomes, using midwifery, obstetric, and transgender health expertise.
Material And Methods:
Prospero protocol CRD 42020159034. Searches combined concepts of "transmasculine," registered/assigned female at birth (AFAB), and "pregnancy," using broad, inclusive sets of MeSH terms and keywords. Database searches: Embase, Maternity and Infant Care and Medline (OVID platform), and CINAHL (EBSCO platform) were searched from 2000 to August 2024, with no language restrictions. Included study references and relevant systematic reviews were also searched.
Results:
From 2166 citations, 44 studies were included, many of which were small and uncontrolled.
Primary Outcome:
The mean proportion of transmasculine people ever having been pregnant (gravidity) was 5.6%-8.5% (47/835-321/3777, range 0%-16.3%), and the mean proportion having had births (parity) was 4.3%-8.5% (35/806-24/284, range 0%-19.1%).
Secondary Outcomes:
The conception rates during testosterone use were low, but insufficient to rely upon as contraception; miscarriage rates appeared high (4/5 studies had rates between 31.6 and 40%-16/40 per person, 156/493 per pregnancy). Similarly, postnatal depression rates (two studies) range 15-58% (3/20-7/12). The limited data available suggested that testosterone use before pregnancy seemed to be associated with fewer conceptions compared to never having taken it, even where transmasculine people had stopped for several months before attempting conception. Pregnancy loss seemed to be higher in those exposed to testosterone antenatally. There was no or inadequate data on most other important outcomes, including access to care, assisted reproduction, stillbirths, and obstetric and neonatal complications.
Conclusions:
A significant minority of transmasculine people become pregnant, including after transition. The miscarriage findings warrant further investigation. Reproductive and maternity services should adapt, although minimal information risks negative consequences for users and providers, potentially adding to the lack of trust. Better data collection and research are urgently required in order to provide effective services.
