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.
Attempts to Conceive and the COVID-19 Pandemic: Data from the Apple Women’s Health Study