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Purpose:  Given elevated pregnancy rates, fluctuating sexual identity, and varying sexual experience among adolescent sexual minority women (ASMW; lesbian/bisexual identity, attraction to/sex with females), research should assess adolescent pregnancy by sexual attraction with identity and experience. This study examined associations of three aspects of sexuality-identity, attraction, and experience-with pregnancy among ASMW versus non-ASMW.  Methods:  Population-weighted data were drawn from the 2002 to 2015 National Survey of Family Growth (NSFG), 15- to 19-year-old female subsample ( n  = 5481). Multivariable logistic regression models (adjusted for age, race/ethnicity, and survey cycle) compared pregnancy among ASMW versus non-ASMW by sexual identity, attraction, and experience separately, and in a combined model in which interaction of aspects of sexuality and survey cycle was tested. The combined model was then stratified by survey cycle.  Results:  Although not significant in the combined model, sexual minority versus heterosexual identity (adjusted odds ratio [aOR] = 1.74, 95% confidence interval [CI] = 1.21-2.51, p  = 0.003) and sexual minority versus exclusive male attraction (aOR = 1.49, 95% CI = 1.10-2.01, p  = 0.011) individually predicted higher pregnancy odds. There was significant interaction between attraction and survey cycles. Sexual minority attraction predicted significantly decreased pregnancy odds (aOR = 0.59, 95% CI = 0.38-0.90, p  = 0.014) in combined 2002 to mid-September 2013 NSFG data, but increased odds (aOR = 1.59, 95% CI = 0.63-4.02, p  = 0.324) in the rest of 2013-2015.  Conclusion:  These results suggest the importance of measuring sexual attraction when examining pregnancy disparities among ASMW. Sex education and teen pregnancy prevention programs should reflect sexual diversity.

Sexual Orientation and Pregnancy Among Adolescent Women in the National Survey of Family Growth, 2002–2015