Original Research
Gynecology
Attempts to conceive and the COVID-19 pandemic: data from the Apple Women’s Health Study

https://doi.org/10.1016/j.ajog.2022.05.013Get rights and content
Under a Creative Commons license
open access

Background

Previous studies have suggested that emergent events may affect pregnancy planning decisions. However, few have investigated the effect of factors related to the COVID-19 pandemic on pregnancy planning, measured by attempting conception, and how attempting conception status may differ by individual-level factors, such as social status or educational level.

Objective

This study aimed to examine the effects of factors related to the COVID-19 pandemic, until March 2021, on attempting conception status and to assess the effect measure modification by educational level and subjective social status.

Study Design

We conducted a longitudinal analysis within a subgroup of 21,616 participants in the Apple Women’s Health Study who enrolled from November 2019 to March 2021, who met the inclusion criteria, and who responded to the monthly status menstrual update question on attempting conception status (yes or no). Participants reporting hysterectomy, pregnancy, lactation, or menopause were excluded. We used generalized estimating equation methodology to fit logistic regression models that estimate odds ratios and 95% confidence intervals for the association between the proportion of participants attempting conception and the month of response (compared with a prepandemic reference month of February 2020) while accounting for longitudinal correlation and adjusting for age, race and ethnicity, and marital status. We stratified the analysis by social status and educational level.

Results

We observed a trend of reduced odds of attempting conception, with an 18% reduction in the odds of attempting conception in August 2020 and October 2020 compared with the prepandemic month of February 2020 (August odds ratio: 0.82 [95% confidence interval, 0.70–0.97]; October odds ratio: 0.82 [95% confidence interval, 0.69–0.97). The participants with lower educational level (no college education) experienced a sustained reduction in the odds of attempting to conceive from June 2020 to March 2021 compared with February 2020, with up to a 24% reduction in the odds of attempting to conceive in October 2020 (odds ratio, 0.76; 95% confidence interval, 0.59–0.96). Among participants that were college educated, we observed an initial reduction in the odds of attempting to conceive starting in July 2020 (odds ratio 0.73; 95% confidence interval, 0.54–0.99) that returned near prepandemic odds. Moreover, we observed a reduction in the odds of attempting to conceive among those with low subjective social status, with a decline in the odds of attempting to conceive beginning in July 2020 (odds ratio, 0.83; 95% confidence interval, 0.63–1.10) and continuing until March 2021 (odds ratio, 0.79; 95% confidence interval, 0.59–1.06), with the greatest reduction in odds in October 2020 (odds ratio, 0.67; 95% confidence interval, 0.50–0.91).

Conclusion

Among women in the Apple Women’s Health Study cohort, our findings suggested a reduction in the odds of attempting to conceive during the COVID-19 pandemic, until March 2021, particularly among women of lower educational level and lower perceived social status.

Key words

desire to conceive
educational level
health-related decision-making
pandemic social and environmental factors
perceived social status
pregnancy planning
women’s health

Cited by (0)

V.F. and G.L. share first authorship.

Apple Inc and the Intramural Research Program of the National Institute of Environmental Health Sciences, National Institutes of Health (NIH) support D.D.B. and A.M.J.

S.M. receives research funding from the NIH, National Science Foundation, and March of Dimes. R.H. receives research funding from the NIH. B.A.C. receives research funding from the NIH and the US Environmental Protection Agency. J.P.O. receives research funding from the NIH, Boehringer Ingelheim. J.P.O. received an unrestricted gift from Mindstrong Health in 2018. J.P.O. is a cofounder of a recently established commercial entity that operates in digital phenotyping outside of women’s health. G.L. is a full-time employee of Valo Health, a technology company. The contribution of S.S. to this publication was as a paid consultant to Apple, Inc. S.S. is not providing this material as part of her Stanford University duties or responsibilities. The other authors report no conflict of interest. This study received funding from Apple, Inc.

Cite this article as: Fruh V, Lyons G, Scalise AL, et al. Attempts to conceive and the COVID-19 pandemic: data from the Apple Women’s Health Study. Am J Obstet Gynecol 2022;227:484.e1-17.