Pregnancy intentions by sexual orientation among pregnancies across the life course

Sexual minority (SM) people may be at increased risk of "unintended" pregnancies, but limited research has examined potential disparities. We examined the intention status of lifetime pregnancies by sexual orientation. We pooled data from the Nurses' Health Study 3 and Growing Up Today Study (n = 36 967 pregnancies 1978-2024). Using multinomial models, we estimated relative risk ratios (RRRs) for pregnancy intention (actively trying/wanted then or sooner, not trying but glad, wanted later but not then, and unwanted then and in the future) among SM groups (completely heterosexual with same-sex experience, mostly heterosexual, bisexual, and lesbian/gay) versus completely heterosexual participants with no same-sex experience. Model predicted probabilities show that 15%-33% of pregnancies within each sexual orientation group were wanted later/unwanted. Compared to pregnancies to completely heterosexual participants with no same-sex experience, all SM groups had more pregnancies that were wanted later (RRRs from 1.22 [completely heterosexual with same-sex experience] to 2.28 [bisexual]) and unwanted then and in the future (RRRs ranging from 1.74 [completely heterosexual with same-sex experience] to 5.23 [bisexual participants]), compared to pregnancies occurring when participants were actively trying/wanted the pregnancy then or sooner. Our findings suggest that pregnancies among SM groups disproportionately are unwanted or occur too early.