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: , 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.