(633) Distant, but connected: pregnancy app utilization in maternity care deserts

Maternity care deserts (MCDs), or counties with no hospitals or birth centers offering obstetric care and no obstetric providers, account for one-third of all U.S. counties. MCDs are expected to grow with projected obstetric provider shortages. Digital health solutions are positioned as solutions to deliver prenatal education and care for pregnant patients in MCDs. However, little is known about digital health utilization among pregnant patients in MCDs. This analysis explores in-app behavior, demographics, and maternity care desert status of a pregnancy tracking app’s userbase.

Study Design: Deidentified self-reported demographic and app usage data from users who downloaded a popular mobile pregnancy tracking app between 1/1/2022 and 7/31/2024 were assessed. The app provides gestational-age appropriate educational content and encourages symptom logging throughout pregnancy. MCD status was assigned using self-reported ZIP code.

Results:

A total of n=411,617 users qualified for inclusion. Users represented all 50 states. Almost 9% of app users lived in a maternity care desert, over double the proportion of U.S. women aged 18-44 living in MCDs (3.8%). Comparatively, 79% of app users lived in counties with full access (FA) to maternity care, where 89% of women aged 18-44 live. Users in MCDs were more likely to be multiparous, have a high school degree or lower educational attainment, subscribe to public insurance, report financial insecurity, and identify as American Indian or Alaska Native than users in full access counties. Users in MCDs were active in the app for 3.2 months on average, compared to 4.2 months for FA users. Almost all users enrolled in their first trimester of pregnancy. Users in MCDs logged fewer total sessions and had shorter engagement durations than FA users.

Conclusion: These results suggest reproductive-aged women in MCD’s are proportionally more likely to download this pregnancy tracking app compared to those in full access counties, and indicate pregnant people in MCDs may be receptive to digital health interventions to support prenatal and reproductive health.