Does anyone fit the average? Describing the heterogeneity of pregnancy symptoms using wearables and mobile apps
Bibliographic record
Abstract
Abstract Wearables, apps and other remote smart devices can capture rich, objective physiologic, metabolic, and behavioral information that is particularly relevant to pregnancy. The objectives of this paper were to 1) characterize individual level pregnancy self-reported symptoms and objective features from wearables compared to the aggregate; 2) determine whether pregnancy self-reported symptoms and objective features can differentiate pregnancy-related conditions; and 3) describe associations between self-reported symptoms and objective features. Data are from the Better Understanding the Metamorphosis of Pregnancy study, which followed individuals from preconception to three-months postpartum. Participants (18-40 years) were provided with an Oura smart ring, a Garmin smartwatch, and a Bodyport Cardiac Scale. They also used a study smartphone app with surveys and tasks to measure symptoms. Analyses included descriptive spaghetti plots for both individual-level data and cohort averages for select weekly reported symptoms and objective measures from wearables. This data was further stratified by pregnancy-related clinical conditions such as preeclampsia and preterm birth. Mean Spearman correlations between pairs of self-reported symptoms and objective features were estimated. Self-reported symptoms and objective features during pregnancy were highly heterogeneous between individuals. While some aggregate trends were notable, including an inflection in heart rate variability approximately eight weeks prior to delivery, these average trends were highly variable at the n-of-1 level, even among healthy individuals. Pregnancy conditions were not well differentiated by objective features. With the exception of self-reported swelling and body fluid volume, self-reported symptoms and objective features were weakly correlated (mean Spearman correlations <0.1). High heterogeneity and complexities of associations between subjective experiences and objective features across individuals pose challenges for researchers and highlights the dangers in reliance on aggregate approaches in the use of wearable data in pregnant individuals. Innovation in machine learning and AI approaches at the n-of-1 level could help to accelerate the field. Author Summary The objective physiological and behavioral information from wearable and other smart devices is uniquely relevant to pregnancy. The objectives of this study were to: 1) describe the individual-level variability of pregnancy self-reported symptoms and objective wearable measures; 2) determine whether this variability can be explained by pregnancy clinical conditions; and 3) determine whether pregnancy self-reported symptoms are associated with objective wearable measures. Data are from the Better Understanding the Metamorphosis of Pregnancy study, which followed individuals from preconception to three-months postpartum. Participants (18-40 years) used an Oura smartring, a Garmin smartwatch, and a Bodyport Cardiac Scale alongside a study app to track self-reported symptoms. High heterogeneity was observed in self-reported pregnancy symptoms, and objective measures such as heart rate variability, activity and sleep over pregnancy that were dissimilar to the population average of these measures. Pregnancy clinical conditions did not explain well the observed high variability in objective wearable measures while self-reported symptoms were weakly correlated with objective wearable measures over pregnancy. In sum, high heterogeneity and complexities of associations between subjective experiences and objective measures from wearables across pregnant individuals pose challenges for researchers. Innovation in machine learning and AI individual level approaches will help to accelerate the field.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".