Life Course Financial Hardship and Fecundability in a North American Preconception Cohort Study.

Background: The effects of life course financial hardship on fertility have not been well studied.

Methods: We examined the association between life course financial hardship and fecundability in Pregnancy Study Online (PRESTO), a preconception cohort study of US and Canadian pregnancy planners aged 21-45 years who identified as female (2013-2023; N = 6,377). We followed participants up to 12 months or until pregnancy. Participants reported financial hardship in childhood (≤11 years), adolescence (12-17 years), and adulthood (≥18 years) via three questions: not having enough money for living expenses; needing to borrow money for medical expenses; or receiving public assistance. We used inverse probability-weighted proportional probabilities models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), accounting for time-dependent confounding and selection bias.

Results: Compared with no financial hardship, financial hardship during any life stage was associated with slightly reduced fecundability (FR = 0.93, 95% CI: 0.86, 1.0). Associations were similar for financial hardship during childhood and adolescence; however, those experiencing financial hardship during adulthood had lower fecundability (FR = 0.83, 95% CI: 0.77, 0.90). The association between adolescent financial hardship and fecundability was similar among those with and without childhood financial hardship. However, the association of adult financial hardship with fecundability was stronger among those who experienced hardship earlier in life (i.e., adult financial hardship among those with child/adolescent financial hardship: FR = 0.77; 95% CI: 0.64, 0.93).

Conclusion: Adulthood is a sensitive period for the effects of financial hardship on fecundability. Moreover, cumulative financial hardship across the life course was associated with greater reductions in fecundability.