Evaluating participant engagement in a preconception cohort study in relation to the Dobbs decision

Mary D Willis; Molly N Hoffman; Tanran R Wang; Erika L Sabbath; Andrea S Kuriyama; Amelia K Wesselink; Lauren A Wise

doi:10.1111/ppe.13080

Evaluating participant engagement in a preconception cohort study in relation to the Dobbs decision

Paediatr Perinat Epidemiol. 2024 Apr 26. doi: 10.1111/ppe.13080. Online ahead of print.

Authors

Mary D Willis¹, Molly N Hoffman¹, Tanran R Wang¹, Erika L Sabbath², Andrea S Kuriyama¹, Amelia K Wesselink¹, Lauren A Wise¹

Affiliations

¹ Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
² Boston College School of Social Work, Chestnut Hill, Massachusetts, USA.

PMID: 38666636
DOI: 10.1111/ppe.13080

Abstract

Background: On June 24th, 2022, the United States (US) Supreme Court's ruling in Dobbs v. Jackson, et al. (hereafter, the Dobbs decision) removed federal-level protections for induced abortion, sparking concerns about reproductive rights and health privacy. Although other pregnancy outcomes (e.g. spontaneous abortion, ectopic pregnancy) are not explicit targets of post-Dobbs abortion bans, study participants may be worried about how their reproductive health data are used by researchers in the post-Dobbs era.

Objective: To evaluate the extent to which the Dobbs decision influenced participant's engagement in a preconception cohort study.

Methods: We leveraged data spanning 20 weeks before and after the Dobbs decision (4 February 2022, to 11 November 2022) from US participants in Pregnancy Study Online (PRESTO), an internet-based prospective preconception cohort study of couples attempting conception. We categorised participants' state-level abortion access by residential location: banned or restricted rights; limited access; and protected rights. We evaluated three participant engagement outcomes: follow-up questionnaire completion; report of a pregnancy; and clicking on the invitation link for a fertility-tracking app. We fit separate linear regression models and restricted cubic splines to compare outcome prevalence before and after the Dobbs decision by state-level abortion category.

Results: A total of 585 newly enrolled participants and 1247 already-enrolled participants received 2802 invitations to complete a follow-up questionnaire. In states with limited or protected abortion rights, we observed little change in participant engagement. In states with banned or restricted abortion rights, however, we observed a 27.12 percentage point reduction (95% confidence interval -43.68, -10.51) in the prevalence of clicking on the invitation link for the fertility-tracking app comparing the post- versus pre-Dobbs periods.

Conclusions: There was some evidence of reduced participant engagement after the Dobbs decision in states with banned or restricted abortion rights, indicating potentially deleterious effects on the conduct of reproductive health studies.

Keywords: cohort study; geographic factors; health policy; observational study; reproductive rights; spontaneous abortion.

Abstract

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