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      Pregnancy and health in the age of the Internet: A content analysis of online “birth club” forums

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          Abstract

          Background

          Although studies report that more than 90% of pregnant women utilize digital sources to supplement their maternal healthcare, little is known about the kinds of information that women seek from their peers during pregnancy. To date, most research has used self-report measures to elucidate how and why women to turn to digital sources during pregnancy. However, given that these measures may differ from actual utilization of online health information, it is important to analyze the online content pregnant women generate.

          Objective

          To apply machine learning methods to analyze online pregnancy forums, to better understand how women seek information from a community of online peers during pregnancy.

          Methods

          Data from seven WhatToExpect.com “birth club” forums (September 2018; January-June 2018) were scraped. Forum posts were collected for a one-year period, which included three trimesters and three months postpartum. Only initial posts from each thread were analyzed (n = 262,238). Automatic natural language processing (NLP) methods captured 50 discussed topics, which were annotated by two independent coders and grouped categorically.

          Results

          The largest topic categories were maternal health (45%), baby-related topics (29%), and people/relationships (10%). While pain was a popular topic all throughout pregnancy, individual topics that were dominant by trimester included miscarriage (first trimester), labor (third trimester), and baby sleeping routine (postpartum period).

          Conclusion

          More than just emotional or peer support, pregnant women turn to online forums to discuss their health. Dominant topics, such as labor and miscarriage, suggest unmet informational needs in these domains. With misinformation becoming a growing public health concern, more attention must be directed toward peer-exchange outlets.

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          Most cited references42

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          Addressing Health-Related Misinformation on Social Media

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            ACOG Committee Opinion No. 736

            (2018)
            The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders should be counseled regarding the importance of timely follow-up with their obstetrician-gynecologists or primary care providers for ongoing coordination of care. During the postpartum period, the woman and her obstetrician-gynecologist or other obstetric care provider should identify the health care provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit. Obstetrician-gynecologists and other obstetric care providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants. This Committee Opinion has been revised to reinforce the importance of the "fourth trimester" and to propose a new paradigm for postpartum care.
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              Internet use in pregnancy informs women's decision making: a web-based survey.

              Internet access and usage is almost ubiquitous, providing new opportunities and increasing challenges for health care practitioners and users. With pregnant women reportedly turning to the Internet for information during pregnancy, a better understanding of this behavior is needed. The objective of this study was to ascertain why and how pregnant women use the Internet as a health information source, and the overall effect it had on their decision making. Kuhlthau's (1993) information-seeking model was adapted to provide the underpinning theoretical framework for the study. The design was exploratory and descriptive. Data were collected using a valid and reliable web-based questionnaire. Over a 12-week period, 613 women from 24 countries who had confirmed that they had used the Internet for pregnancy-related information during their pregnancy completed and submitted a questionnaire. Most women (97%) used search engines such as Google to identify online web pages to access a large variety of pregnancy-related information and to use the Internet for pregnancy-related social networking, support, and electronic commerce (i.e., e-commerce). Almost 94 percent of women used the Internet to supplement information already provided by health professionals and 83 percent used it to influence their pregnancy decision making. Nearly half of the respondents reported dissatisfaction with information given by health professionals (48.6%) and lack of time to ask health professionals questions (46.5%) as key factors influencing them to access the Internet. Statistically, women's confidence levels significantly increased with respect to making decisions about their pregnancy after Internet usage (p < 0.05). In this study, the Internet played a significant part in the respondents' health information seeking and decision making in pregnancy. Health professionals need to be ready to support pregnant women in online data retrieval, interpretation, and application.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Methodology
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – original draft
                Role: VisualizationRole: Writing – review & editing
                Role: Formal analysis
                Role: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 April 2020
                2020
                : 15
                : 4
                : e0230947
                Affiliations
                [1 ] Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States of America
                [2 ] Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States of America
                [3 ] Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States of America
                Jagiellonian University Medical College, POLAND
                Author notes

                Competing Interests: Within the last five years, HC has owned (but no longer owns) individual stocks in healthcare, pharmaceutical, and finance companies. HC is also a member of the American College of Obstetricians and Gynecologists, and participates with their lobbying efforts at both the state (Pennsylvania) and national level for legislation that affects women's health. She is a member of ACOG's Patient Education Review Panel, which writes and reviews patient education materials. The other authors have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-6723-9038
                http://orcid.org/0000-0001-7709-3813
                Article
                PONE-D-20-00106
                10.1371/journal.pone.0230947
                7156049
                32287266
                6d2e88ce-77ca-4dbe-b3ef-f3d230900c8b
                © 2020 Wexler et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 January 2020
                : 12 March 2020
                Page count
                Figures: 4, Tables: 0, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000052, NIH Office of the Director;
                Award ID: DP5OD026420
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000092, U.S. National Library of Medicine;
                Award ID: R01LM011176
                Award Recipient :
                AW acknowledges support from the Office of the Director, National Institutes of Health (NIH), grant number DP5OD026420 ( https://www.nih.gov/institutes-nih/nih-office-director). GGH acknowledges support from the NIH, National Library of Medicine (NLM) grant number R01LM011176 ( https://www.nlm.nih.gov/). The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH nor of the NLM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Computer and Information Sciences
                Computer Networks
                Internet
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Pregnancy Complications
                Miscarriage
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Pregnancy Complications
                Miscarriage
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Research and Analysis Methods
                Database and Informatics Methods
                Information Retrieval
                Custom metadata
                Due to the Terms of Use of the health forum we used ( https://www.whattoexpect.com/terms-of-use/) explicitly prohibiting reproduction or redistribution of materials made available on their platform, we cannot make the dataset of user posts directly available. However, the processed data (the topics resulting from the algorithm described), detailed per-topic statistics, and code used to compute the topic model--along with specific instructions on how to recreate our dataset--are now available at https://healthlanguageprocessing.org/pregnancy-forums/.

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