Disparities in Substance Use and Psychological Distress During Pregnancy Among Pregnant Bisexual and Heterosexual Females in the United States, 2021–2023

PURPOSE: Bisexual women are an understudied population in perinatal health research, despite evidence of elevated behavioral health risks. This study examined differences in substance use and psychological distress during pregnancy between bisexual and heterosexual females. METHODS: = 1888). Outcomes included past-month marijuana use, alcohol use, binge drinking, cigarette smoking, and psychological distress. Poisson regression was used to estimate risk ratios, both unadjusted and adjusted for sociodemographic factors. RESULTS: Compared with heterosexual females, bisexual females reported higher prevalence of marijuana use (21.4% vs. 4.9%) and psychological distress (19.6% vs. 6.5%) during pregnancy; disparities persisted after adjustment for sociodemographic factors. Bisexual females also reported higher prevalence of smoking during pregnancy, although differences were not significant in adjusted models. Substance use and distress declined from preconception to pregnancy in both groups, but percentage declines in alcohol and marijuana use were smaller among bisexual females. Marriage, parenthood, and higher income were associated with reduced substance use and psychological distress among heterosexual females but less so for bisexual females. CONCLUSION: Pregnant bisexual females experienced elevated risks of marijuana use and psychological distress compared with pregnant heterosexual females, and protective social resources appeared less impactful. These findings underscore the importance of inclusive, affirming perinatal care and highlight the need for research and interventions that address the unique stressors and contexts shaping bisexual women's perinatal experiences.