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Am J Obstet Gynecol. 2022 May 11:S0002-9378(22)00357-X. doi: 10.1016/j.ajog.2022.05.013. Online ahead of print.
BACKGROUND: Previous studies have suggested emergent events may affect pregnancy planning decisions. However, few have investigated the impact 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 education level.
OBJECTIVE: To examine the effects of factors related to the COVID-19 pandemic, through March 2021, on attempting conception status. To assess effect measure modification by education level and subjective social status (SSS).
STUDY DESIGN: We conducted a longitudinal analysis within a subgroup of 21,616 participants in the Apple Women’s Health Study (AWHS) who enrolled from November 2019-March 2021, met inclusion criteria, and who responded to the monthly status menstrual update question on attempting conception status (yes/no). Those reporting hysterectomy, pregnancy, lactation, or menopause were excluded. We used generalized estimating equation (GEE) methodology to fit logistic regression models that estimate odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between the proportion of those who were attempting conception each month (compared to a pre-pandemic reference month of February 2020), while accounting for longitudinal correlation and adjusting for age, race/ethnicity, and marital status. We stratified analysis by social status and education level.
RESULTS: We observed a trend of reduced odds of attempting conception, with an 18% reduction in the odds of attempting conception in August and October 2020 compared to the pre-pandemic month of February 2020 (August OR: 0.82, 95% CI: 0.70, 0.97; October OR: 0.82, 95% CI: 0.69, 0.97).Participants with lower education level (no college education) experienced a sustained reduction in odds of attempting to conceive from June 2020 to March 2021 when compared to February 2020, with up to a 24% reduction in the odds of attempting to conceive in October 2020 (OR: 0.76, 95% CI: 0.59, 0.96). Among participants that were college educated, we observed an initial reduction in odds of attempting to conceive starting in July 2020 (OR: 0.73, 95% CI: 0.54, 0.99) that returned near pre-pandemic odds. We also observed a reduction in odds of attempting to conceive among those with low SSS, with a decline in odds of attempting to conceive beginning in July 2020 (OR: 0.83, 95% CI: 0.63, 1.10) and continuing through March 2021 (OR: 0.79, 95% CI: 0.59, 1.06), with the greatest reduction in odds in October 2020 (OR: 0.67, 95% CI: 0.50, 0.91).
CONCLUSION: Among women in the AWHS cohort, our findings suggest a reduction in the odds of attempting to conceive over the course of the COVID-19 pandemic, through March 2021, particularly among women of lower education level and lower perceived social status.