Data-driven insights can transform women's reproductive health

50. Furthermore, confounding variables present a perva- sive challenge throughout science, po tentially masking the true effects of the variable of interest by being associated with both the exposure and the outcome 51. In response to these challenges, we advocate for the continued improvement of resear ch methods through the develop- ment and incorporation of standardized protocols 52 and validation efforts 53. Moreover, the adoption of transparent reporting practices, such as those laid out by CONSORT and STROBE initiatives 54 or the Cell Press STAR Methods model 55, will enhance reproducibility and underpin the integrity and credibility of data-driven findings in women ’s reproductive health. While advancements on the data collection and technical analysis

fronts are essential to exploring concerns in women’sh e a l t h ,i ti s crucial to consider the impact of social determinants of health on patients’ presentations and clinical outcom es. For example, patients from low socioeconomic status who rely on Medicare or Medicaid or are under- or uninsured may not have reliable a ccess to a physician to help manage gynecological conditions, causing adverse health outcomes56.I na d d i t i o n , medical racism is a culprit in the increased preterm birth rates in non-white women in the US57, and inequalities that can manifest in different forms— such as maternal stress and environmental exposure to toxins due to his- torical redlining—can contribute to preterm birth risk, as surveyed by epigenetic and gene-environment interaction studies58. Thus, it is crucial to adopt an intersectional approach to studying women’s health conditions, taking into account how cultural, soc ioeconomic, geographic, and racial disparity factors influence patients’ outcomes and healthcare experiences, which can inform a more holistic understanding of disease and contribute to improved approaches to care. A good first step would be to recruit larger, more diverse cohorts for studies to represent more realistic patient popu- lations. Studies of women’s reproductive health should not focus solely on a person’s ability to have children or not but consider the individual holi- stically, including mental health and quality of life. Challenges going forward will not necessarily be generating sufficient amounts of data for computational a nalyses but accurate phenotyping strategies, refining the analytical methods to gain greater biological insights, expanding on computational drug discovery opportunities for the advancement of therapeutics,finding ways that large language models and other new technological developments can enable discoveries, and bringing closer to reality the promise of precision medicine. Integrating and ana- lyzing different types of -omics data to study women’sh e a l t hc o n d i t i o n sc a n provide revelations in causes of disease and targets for treatment 59.M u l t i - omics approaches have resulted in greater insights into biological signals associated with term and preterm birth 60,61 and could be increasingly leveraged to better understand pregnancy and other women’sh e a l t hc o n - ditions. Moreover, digital twins c an provide a data-driven way of mon- itoring, modeling, and managing conditions that can be tailored to an individual’s specific needs by integrating real-time data from various sources (e.g., clinical records, sensors, mobilehealth tracking applications, wearable devices) and artificial intelligence 62. Digital twin technology could offer a transformative approach to women’s reproductive health, from identifying potential pregnancy complication s early to managing endometriosis symptoms,finding optimal drugs and doses for treatments, and more. It is imperative, however, that we ensure discoveries from future research and technologies developed for women’s reproductive health do not widen the gap between those who are well-represented and privileged and those from under-represented and under-resourced backgrounds. Expanding on how we leverage molecular, clinical, sociocultural, and other data combined with robust computational integrative a pproaches for discoveries while we prioritize broader representation in studies will benefitn o tj u s tw o m e n’s reproductive health but all areas of human health for everyone. Received: 1 February 2024; Accepted: 20 April 2024;

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The authors would like to thank Jean Costello, Claire Dubin, and Boris Oskotsky for their helpful discussion and advice. This work was funded by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [P01 HD106414- 01, P01 HD106414-02, R01 HD105256] and the March of Dimes Prematurity Research Center at UCSF [60982053-50185]. The funders played no role in the study design, data collection, analysis and interpretation of data, or the writing of this manuscript. Author contributions T.T.O., O.Y., U.K., L.A. and M.S. wrote the main manuscript text, and T.T.O. and M.S. prepared Fig. 1. All authors reviewed the manuscript. Competing interests The authors declare no competing interests. Additional information Correspondenceand requests for materials should be addressed to Tomiko T. Oskotsky or Marina Sirota. Reprints and permissions informationis available at http://www.nature.com/reprints Publisher’s noteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article ’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . © The Author(s) 2024 https://doi.org/10.1038/s44294-024-00019-x Perspective npj Women's Health | (2024) 2:14 6