Prepregnancy Lifestyle Risk Factors in Women Seeking Digital Fertility Services: Cross-Sectional Descriptive Study.

BACKGROUND

Approximately 1 in 3 pregnancies in the United States are complicated by one or more adverse pregnancy outcomes. This high prevalence contributes to the elevated rates of maternal and infant mortality in the United States. Modifiable prepregnancy or preconception lifestyle factors have been associated with adverse pregnancy outcomes in observational studies, which underscores the importance of preconception care.

OBJECTIVE

This cross-sectional descriptive study aimed to (1) estimate the prevalence of preconception lifestyle risk factors among women seeking services from a digital fertility platform, (2) characterize the study population and present relevant reference data, and (3) examine the distribution of prepregnancy lifestyle scores across demographic and clinical subgroups.

METHODS

The digital health company, Doveras Fertility, has built a prepregnancy digital health platform for individuals and couples seeking to optimize their fertility potential. Targeting users prior to initiation of pregnancy, the platform facilitates the assessment of baseline lifestyle risk factors. This paper reports on 396 adult women who sought the platform's services in a 1-month period between May and June 2024 by completing a digital fertility questionnaire. Self-reported data were analyzed for 6 healthy prepregnancy lifestyle factors known to be associated with maternal health outcomes in prior observational studies, and each participant was given a composite score between 0 to 6 to represent the number of these healthy behaviors reported. The 6 healthy prepregnancy lifestyle factors include a BMI of 18.5 to 24.9 kg/m2, not currently smoking, ≥150 min/week of moderate to vigorous physical activity, healthy eating, no daily alcohol intake, and use of a prenatal multivitamin.

RESULTS

The study population was racially and ethnically diverse, with a mean age of 32.9 (SD 6.3) years. Most (235/396, 59%) participants received a composite score of 3 factors or fewer, and less than 5% (19/396) scored 6 out of 6. For context, this cohort had higher proportions of participants with unhealthy BMI and dietary patterns than those in the reference data. Regarding fertility, 46% (182/396) met the clinical definition of infertility (≥1 year trying to conceive), with the prevalence of infertility ranging from 16% (3/19) among those with the highest lifestyle scores to 59% (17/29) among those with the lowest.

CONCLUSIONS

Most women seeking services from this digital fertility platform exhibited multiple lifestyle factors that have been previously associated with adverse pregnancy outcomes in observational studies. These results suggest that nearly all survey participants have potential risk factors for adverse maternal outcomes and therefore the potential to adopt at least one improvement in their lifestyle behavior. A digital platform may offer an accessible mechanism for identifying and characterizing preconception risk factors; however, future longitudinal studies are needed to evaluate whether platform-based interventions can effectively support behavior change and improve maternal health outcomes.