Future directions
Based on the described gaps in clinical care, research, and educational, we propose several key points for future directions in these areas (Box 1). It is essential for researchers to educate themselves on the use of the correct terminology more consistently in order to curate future knowledge that would be of value to clinicians. Research priorities would include the examination of discrepancies in pregnancy outcomes and associated predictors and risk factors, utilize qualitative methods to examine prenatal care experiences and identify barriers to care, and assess interventions aimed at improving access to care as well as perinatal and pregnancy success outcomes. Similarly to mandates to include women and sex as a biological variable in research proposals instituted in the past couple of decades by some governmental funding bodies, sexual minority individuals should only be excluded for scientific reasons rather than convenience. In regard to clinical care, efforts should be made to create an inclusive environment, with presence of multidisciplinary clinical teams at least at larger medical centers to provide appropriate patient care before, during and after pregnancy. From an educational point of view, training on sex and gender minority individuals should be incorporated in medical school curricula, in obstetrics and gynecology graduate medical education, and into subspecialty care at all levels. Finally, from a societal standpoint, we need to rise above societal stigmas that feed into the disenfranchisement of this population and impact health in general, and mental health of sexual minority populations.