A recent study revealed that 67% of pregnant women are not meeting hydration recommendations, with most lacking knowledge of prenatal hydration guidelines. However, the majority of women expressed interest in using digital tools to improve hydration behaviors during their pregnancies.

Researchers from Pennsylvania State University conducted a cross-sectional survey of 137 pregnant women (mean age = 30.9 years, mean gestational age = 20.9 weeks). Their findings were published in PLOS Digital Health.

Methods

Participants completed a one-time, 45-minute online survey via REDCap. The survey assessed knowledge of hydration recommendations, behaviors, and attitudes about digital tools. Mann-Whitney U and chi-squared tests were used to determine group differences between early (first and second trimesters) and late (third trimester) pregnancy.

Key Findings

The researchers found that 63% of women lacked knowledge of hydration recommendations; 67% reported not meeting hydration recommendations; 59% did not track their fluid consumption; 69% were willing to use digital tools to improve their hydration; and 67% believed a smart water bottle would help them achieve daily fluid goals.

The study found significant differences in hydration knowledge between women in the early and late stages of pregnancy. Women in later pregnancy reported higher recommended daily water intake (2.4 L) compared to those in early pregnancy (1.5 L).

Common barriers to meeting fluid intake guidelines included forgetting to drink (47%), not feeling thirsty (47%), increased urination (33%), feeling bloated and nauseous (20%), and the hassle of carrying a water bottle (24%).

Detailed Results

Nearly 63% of participants were White, while 21.2% were American Indian/Alaskan Native and 5.1% were Asian. Just over 37% were employed full-time, while 28.5% worked part-time and 26.3% were unemployed. About 40% had a bachelor's degree or higher. Three-quarters of participants had an annual income of less than $40,000.

Forty-seven percent of participants reported consuming less than 2.4 L of water per day (the guideline-recommended amount), 37% reported consuming more than 2.4 L/day, and 16% did not know their daily water intake. By pregnancy stage, in early pregnancy, 64% of participants reported <2.4 L/day, 18% >2.4 L/day, and 18% didn't know; in late pregnancy, 45% reported <2.4 L/day, 41% >2.4 L/day, and 14% didn't know.

Seventy percent of participants preferred water/flavored water as their beverage of choice. Sixty-seven percent reported being successful in meeting fluid recommendations only 0-4 days/week. Eighty-three percent reported eating foods high in water content multiple times daily, while 9% reported eating high-water content foods 4-6 days/week and 8% reported eating high-water content foods 0-3 days/week.

Thirty-one percent of participants reported tracking their fluid intake; 26% counted water bottles/refills as a tracking method.

Eighty-two percent of women agreed drinking water is an automatic behavior; 77% agreed they drink water without thinking, and 75% agreed they drink water without conscious effort.

In terms of digital tool use to track and potentially improve hydration, 56% of those surveyed had never installed a hydration-tracking app and 61% had never owned a smart-connected water bottle; however, 69% were interested in using a new smartphone app for hydration tracking, 68% reported they would likely use such an app, and 67% said they were likely to use a smart-connected water bottle. In early pregnancy, 56% had used a hydration app and 44% had used a smart bottle; in late pregnancy: 37% had used a hydration app and 33% had used a smart bottle. No significant differences were found between early and late pregnancy for most digital tool questions (Ps > 0.05).

Limitations

Some limitations of the study included the homogeneous sample (mostly White, fully employed, middle-income women); the cross-sectional design, which may limit understanding of changes over pregnancy course; self-reported data, which may introduce bias or under/over-reporting; and the use of a dichotomous cutoff (2.3 L) for hydration recommendations.

Conclusions

Researchers concluded that these findings highlight the need for increased education and knowledge during preconception and early pregnancy to establish and sustain healthy hydration behaviors throughout pregnancy and postpartum. They suggested that digital tools may help overcome barriers like forgetting to drink and provide motivation through goal-setting and self-monitoring.

The authors have declared that no competing interests exist.