BACKGROUND Preconception care (PCC) should be provided for all women capable of becoming pregnant to identify and treat existing risk factors for adverse perinatal outcomes for both the woman and her future baby. Additional tools are needed for providers and the public to screen for and address preconception health (PCH) risks, particularly for African American (AA) women given the national persistent health outcome and healthcare disparities. We developed and tested the “Gabby System,” featuring an online interactive conversational agent programmed to discuss women’s specific PCH risks and encourage behavioral change through evidence-based interventions. METHODS A 6-month randomized controlled trial of a purposeful, convenience sample of 100 non-gravid, primarily college-attending AA women 18–34 years of age was conducted. All participants were screened at enrollment for over 100 PCH risks and then randomized to the Gabby or control group. Controls were sent a letter listing identified PCH risks, suggesting they discuss these risks with a health care provider. The numbers, proportions, and types of risks identified and addressed were compared between groups. RESULTS Of the 100 women enrolled, 99 provided baseline data, 91 completed the online PCH risk assessment, and 80 completed the 6-month follow-up phone call. The mean participant age was 25.5 years and all had at least one PCH risk with a mean (sd) of 23.7 (5.9), range of 11 to 45 PCH risks. In 6 months the Gabby group had significantly greater reductions compared to controls in both the number of PCH risks (34% higher- 8.3 vs. 5.5, p<.05) and in the proportion of risks resolved (25% higher- 27.8% vs 20.5% p<0.01). Women in the Gabby group averaged 2.9 logins and 63.7 minutes of interaction time. The most common PCH risks triggered were nutrition, activity and infectious disease. The majority of women (78%) reported it “was easy to talk to Gabby” and that they had used information from Gabby to improve their health (64%). CONCLUSION Among a group of reproductive age African American women, use of the Gabby system was associated with a significant reduction in identified PCH risks. More research is needed to determine if Gabby can impact risk status among a larger, more socio-demographically diverse group of black women and if reducing the number of risks is clinically significant.

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