Expect Fitness, Inc.

Maternal mortality and morbidity represent some of the most pressing global challenges. Within this context, gestational diabetes mellitus (GDM) poses a significant threat to life during its earliest stages.According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, 14.7% of women globally were diagnosed with GDM during their pregnancies. Both mother and child are subject to the short- and long-term consequences of this disease. For example, 33% of women with GDM develop Type 2 DM within 5 years of delivery, a figure that rises to 50% for people of color. 

Some data suggest that early intervention may decrease the risk of GDM and related complications such as large-for-gestational age infants, neonatal hypoglycemia, and pre-eclampsia gestational hypertension, preterm birth, stillbirth, and metabolic syndrome in the child later in life. However, there is a lack of research on the most appropriate treatment or methods that may help mitigate the impact of GDM.  For example, while exercise has been shown to help lower glucose for some women, there is little information about the optimal "dose" (type and duration) of exercise needed for the best impact. This lack of focus on exercise and its impact on GDM is a clear unmet need. Since GLP-1s are cost prohibitive for many communities and contraindicated in pregnancy, there is a huge opportunity for alternative approaches to mitigate GDM risk.

The standard treatment for Gestational Diabetes Mellitus (GDM) is a stepwise approach, beginning with diet modification and exercise. If blood sugar levels remain uncontrolled, oral medications or insulin may be added, depending on the severity. Most women receive nutritional counseling and learn to monitor their blood sugars, but specific guidance on exercise is often limited to encouragement to take daily walks or, occasionally, a list of suggested exercises.

Despite the American College of Obstetricians and Gynecologists' report confirming the safety and benefits of modified exercises for both mother and child, implementation is challenging due to the lack of safe, effective, and user-friendly targeted solutions tailored for pregnant women. Safety concerns pose a significant obstacle, leading many pregnant women to avoid exercise or limit themselves to a single, potentially less effective activity for managing blood sugar levels. Additionally, there is a lack of compelling data regarding the optimal intensity or energy expenditure needed to decrease the risk of GDM, emphasizing the need to better understand the optimal exercise dose for expectant mothers.

Available exercise apps have limited ability to customize programming for pregnant women, with few offering the ability to filter for pregnancy-specific exercises. While many pregnancy tracking apps provide some exercise routines, they often lack the ability to fully customize programs to the individual and can be unengaging and racially undiverse. The absence of guidance from practicing OB/GYNs further compounds existing safety concerns. Consequently, many expectant mothers lack access to safe and tailored exercise solutions, highlighting a critical gap in the market.

Expect’s solution is an innovative at-home video streaming platform that aims to modify GDM risk factors through the only pregnancy fitness program in which every workout is approved by OB/GYNs. The on-demand entertainment grade videos, available in multiple languages, can be viewed on any smartphone, removing adoption barriers by providing culturally sensitive content that can be conveniently accessed anytime and anywhere. Our AI-generated recommendations will identify the dose for optimal risk reduction, tailored to each individual and reviewed by OB/GYNs, allowing mothers to feel confident that they are not placing themselves or their babies at undue risk. Expect aims to improve overall health in pregnancy, reduce maternal and neonatal morbidities associated with GDM, and empower mothers to manage their health throughout pregnancy.

Our aim is to empower pregnant women by providing proactive personalized exercise recommendations that modify GDM risk in an on-demand video platform with safe, engaging, and affordable exercises that can be done at home. This approach enables women to take control of their weight management, modifiable GDM risk factors, and enhance their overall health during pregnancy.

Our demo is here: https://www.expect.fit/demo

Expect targets the women who are most impacted by GDM–women of color–and women who cannot access GLP-1s, either due to financial or fertility constraints. In countries such as the United States which lack sufficient maternal healthcare providers, women often lack access to maternal care providers and have the most to gain from engaging in at-home solutions that can mitigate their risk factors. 

To reach these women, Expect has unparalleled diversity, spanning racial, body type, gender, mobility/ability and language for the broadest engagement. Expect content is culturally relevant, spanning from LatinX, Caribbean, hip hop and pop-inspired dance routines. 

Expect offers workouts of varying lengths, from under 10 minutes up to 45 minutes to accommodate different endurance levels and busy schedules. All workouts are on demand, so moms can exercise in their own homes, on their own time. The Expect app is available in the App Store and the Google Play Store, allowing our consumers to stream workouts on their smartphones or cast them to other screens for convenience. 

Maternal fitness is indeed one of the few actionable pathways to reduce maternal mortality. 

In 2020, the American College of Obstetricians and Gynecologists reaffirmed its committee opinion recommending women exercise at least 150 minutes in the prenatal and postnatal periods because of its power to significantly reduce deadly maternal complications such as preeclampsia (pregnancy-related high blood pressure). Expect contacted Dr. Meredith Birsner, the author of the official statement, who shared with us: “If you’re pregnant in America right now there are two things you can readily do to improve outcomes for you and your baby and help save your life: take low dose aspirin and exercise. Low dose aspirin reduces your risk of high blood pressure, but exercise also cuts your risk of high blood pressure, and many, many more complications.” Indeed, studies show that when implemented in a population, maternal fitness is expected to reduce maternal mortality from 12% to 23%.

This is our call to action. Expect is the only pre and postnatal fitness platform where every workout is approved by OB-GYNs. As a result of this distinction, moms ranked Expect as “best in class for safety” in a McKinsey survey. With our entertainment-grade production, advisory of 16 OB-GYNs and a Harvard Medical School professor and prenatal fitness fitness expert guiding us, Expect is positioned to save lives and become the number one maternal fitness company in the world.

Expect CEO and cofounder Dara Cook captivated millions during her 20-year career at MTV, where she was Head Creative of the Video Music Awards, Senior Vice President, and named one of the Most Influential Minorities in Cable. Dara graduated cum laude from the Wharton School of the University of Pennsylvania where she was the first black Joseph Wharton and Ben Franklin Scholar in University of Pennsylvania history. She went on to graduate from the General Management Program at Harvard Business School, where her presentation for Expect won the strategy competition. Dara is currently a Visiting Entrepreneur at Stanford University Graduate School of Business.

Dara’s sister became pregnant with her first child at age 37 and followed her OB-GYN’s orders to exercise. Despite the increased risks of her age and race (black), she had a smooth pregnancy and a 20-minute labor. The delivering OB-GYN credited one thing that set her experience apart: she exercised during pregnancy. Dara later read the overwhelming research about the power of fitness to drastically reduce every major complication during and after pregnancy, and improve the health of babies and realized she could leverage her unique experience in content creation and media business building to save lives through world class maternal fitness content. As a black woman, Dara centers women of color in Expect. 

To build Expect with the most vulnerable communities in mind, Dara has collaborated with Healthy Start organizations, the March of Dimes and the New York City Department of Health in the U.S. to help guide the development of the content and platform. 

CTPO and cofounder Joseph Pacheco, a seasoned tech and product leader, boasts a decade of startup experience in roles spanning CTO, Head of Product, engineer, and more. He's conducted over 1,400 technical interviews, guiding engineers to top-tier roles at firms like Apple and Google. With a magna cum laude degree in Philosophy and Computer Science from the University of Pennsylvania, Joseph excels in product strategy, technical execution, and user experience design.

Chief Fitness Officer Jillian Ternosky won an Emmy for her work with MSG and was the Head of Production for ClassPass. 

As a member of the LGBTQ+ communities, Joseph and Jillian center all families in their approach to Expect.

Special advisors:

Rachel Villanueva MD FACOG is the past President of the National Medical Association,  the largest and oldest organization representing African American physicians and their patients in the United States, and a board-certified OB-GYN.  

I-Min Lee, MBBS, MPH, ScD, FACSM  is Professor of Medicine at Harvard Medical School and a world-renowned expert on physical activity to prevent chronic diseases and enhancing longevity in women’s health. Dr. Lee brings a global perspective: educated in Singapore and the U.S., she has published more than 450 scientific articles, including groundbreaking studies on prenatal fitness’ impact on gestational diabetes and preeclampsia.

Our 15 OB-GYNs are racially diverse, and all women.

University of Alabama at Birmingham (UAB)-Internal Revenue Board approved study with UAB’s Exercise in Pregnancy clinic. 

Veterans Affairs-Expect has recently joined the VA Greenhouse program to engage in collaborative innovation with the VA. The ultimate intent is for Expect to sell a VA-centric version of our solution to the VA, the country’s largest integrated health system. This is a massive opportunity as the number of births covered by the VA has increased 14x since the year 2000.

Point32Health–Expect is newly reimbursable under Point32Health, the second largest insurer in New England and covers over 2.2 million lives.

Penn Medicine’s Helen O Dickens Center for Women’s Health, which serves the largely Medicaid community of West Philadelphia.

New York City Department of Health's Brownsville Neighborhood Health Action Center, which serves a largely Medicaid community.

Healthy Start - Upper Manhattan, which serves a largely Medicaid community.

March of Dimes March for Babies Walk-Expect kicked off March of Dimes’ largest walk in New York City with an exclusive workout.

Expect’s mission is to help women all over the world improve outcomes for themselves and their babies through OB-GYN approved prenatal and postnatal fitness programs designed specifically for their needs.

As we make headway in the United States, our next phase is global, and that’s where we need the help of Solve. After establishing a strong presence in the United States, which has the highest pregnancy-related mortality amongst industrialized nations, Expect will target countries experiencing significant growth in population and health insurance coverage. We are prioritizing nations with robust content production capabilities, allowing us to generate culturally resonant material that deeply connects with audiences and contributes to the local economy. India, Nigeria, the United Kingdom (U.K.), Canada, the Philippines, and Australia are our primary international targets.

We are eager to understand the global landscape and the stakeholders who can be our partners in expanding access to life-saving maternal fitness.

Further, our goal is to enhance our clinical validity, and we are seeking mentorship in clinical tests.

Expect innovates with best in class safety, an accomplished medical advisory team, proprietary dataset to fuel AI, and advanced content creation capabilities. 

Safety: Recognizing Expect’s enormous traction and potential, McKinsey selected Expect as one of only three startups to receive pro bono consulting. As part of our engagement, McKinsey conducted a survey of major pre and postnatal fitness alternatives and found Expect “best in class” for safety, the most important criteria for pre and postnatal fitness alternatives. 

Medical: Expect has an advisory of 16 OB-GYNs representing various disciplines including Maternal-Fetal Medicine and Urogynecology (pelvic floor), along with Rachel Villanueva, the past president of the National Medical Association. Harvard Medical School professor I-Min Lee, the premier world expert on prenatal fitness whose research on exercise in pregnancy helped change global guidelines, is engaged in an exclusive contract with us.  Our team also includes Physical Therapist Nicole Dugan  who served as lead Physical Therapist at Penn Medicine and created our pelvic floor workouts.

Medical Review Process: Expect has operationalized the medical review process into a scalable model. Our physicians actively advise us and drive our proprietary content validation and critique operation.

Proprietary AI model: While most companies employing AI are using external datasets, Expect exclusively owns a proprietary dataset of OB-GYN critique and commentary on thousands of minutes of exercise content. This dataset can train a proprietary AI model to review, reject and approve a broad spectrum of content for the pre and postnatal phases.

Cutting-Edge AI-Generated Content: Expect is pioneering the use of advanced AI to craft Parent-and-Me workouts, extending lifespan of our end customer beyond the postnatal period. Acknowledging the challenges parents face with toddlers interfering with their home workouts, Expect is developing workout content for parents that also features AI-generated, animated figures to simultaneously entertain kids. Additionally, Expect can create custom animated characters for premium subscribers. 

Entertainment Grade-Production: Expect is the only app led by seasoned content creators. CEO Dara Cook spent decades at MTV and was Head Creative of the MTV Video Music Awards, and brand manager of Wild ‘N Out. Our Chief Fitness Officer, Jillian Ternosky, is an Emmy-winner. 

Diversity: Expect has unparalleled diversity, spanning racial, body type, gender, mobility/ability and language for the broadest engagement. 

Pregnancy-related fitness is a blue ocean, without any dominant, incumbent brands.  Expect offers entertainment-grade content with AI-powered precision, a feature typically unavailable in a traditional healthcare platform. 

We already believe that Expect has catalyzed greater diversity in the maternal fitness space: prior to Expect, competing platforms Peloton and Every Mother had no black women in their prenatal content. After Expect, Peloton and Every Mother have included one black woman each in across all of their prenatal content. (In Expect you may find more than one black woman in a single video!).

In a world in which supply-side constraints undermine global maternal health–shortage of OB/GYNs and birthing centers-maternal fitness is one of the few options that empowers women anywhere, anytime, to improve outcomes for themselves and their babies.

The logical pathways through which Expect would revolutionize maternal health are as follows:

Inputs:

• Evidence-based, user-friendly app with tailored exercise programs and educational content

• Collaboration with experts (e.g., obstetricians, exercise physiologists, nutritionists, physical therapists)

• Integration of clinically validated screening tools and risk assessment algorithms

Activities:

• Provide tailored exercise plans and guidance for safe and effective workouts during pregnancy

• Educate users on the importance of physical activity and healthy lifestyle habits in preventing gestational diabetes

• Enable tracking of physical activity levels, weight, and blood glucose levels 

• Facilitate access to virtual consultations with healthcare professionals for personalized support

• Incorporate validated risk assessment tools to identify high-risk individuals and provide appropriate interventions

Outputs:

• Increased adoption of Expect among pregnant women, especially those at risk for gestational diabetes

• Improved adherence to recommended exercise routines and healthy lifestyle habits

• Enhanced access to evidence-based information and support from healthcare professionals

• Early identification of high-risk individuals through risk assessment tools

Outcomes:

• Improved physical activity levels and healthy weight management during pregnancy

• Better glycemic control and reduced risk of developing gestational diabetes

• Increased awareness and knowledge about gestational diabetes prevention strategies

• Improved self-efficacy and empowerment in managing one's health during pregnancy

Impact:

• Reduced incidence of GDM and associated complications (e.g., macrosomia, preeclampsia, cesarean delivery)

• Improved maternal and fetal health outcomes

• Potential long-term benefits for the mother and child, such as reduced risk of developing type 2 diabetes and obesity later in life

• Cost savings for the healthcare system by preventing or better managing gestational diabetes and its complications

By combining tailored exercise programs, education, risk assessment, and access to professional support, Expect aims to empower and equip pregnant women with the necessary tools and knowledge to reduce their risk of developing gestational diabetes through evidence-based interventions.

Gestational Diabetes Mellitus (GDM) has far-reaching consequences, but by modifying risk factors before and during pregnancy, we may be able to reduce its prevalence and severity. Exercise has been shown to lower fasting and 2-hour postprandial blood glucose levels, which are markers of GDM. A meta-analysis revealed that exercise alone reduces both fasting and postprandial glucose levels. Furthermore, Davenport et al.found that women who engaged in 140 minutes of moderate-intensity exercise per week had a 25% lower incidence of GDM16. Despite these findings, comprehensive guidance to help pregnant women achieve these exercise goals is lacking.

To validate the effectiveness of our approach, we will conduct a clinical trial focusing on women with pre-pregnancy polycystic ovarian syndrome (PCOS), a condition that elevates the risk of gestational diabetes mellitus (GDM). The study aims to evaluate the impact of personalized, AI-driven exercise recommendations on blood glucose levels by identifying the fitness dose(s) to optimize risk reduction, GDM incidence rates, patient compliance, and satisfaction in this high-risk population.Participants’ glucose levels will be closely monitored, and any adverse events will be tracked to ensure the safety of the intervention.

We will also collect exploratory data to investigate the potential benefits of Expect, such as rates of preeclampsia, preterm births, and post-partum depression. The insights gained from this data will expand the Expect AI platform, enabling it to analyze data] and provide valuable information for identifying, monitoring, treating, or preventing pregnancy-related risk factors.

By offering an enjoyable exercise program tailored to the needs of diverse pregnant women and guided by OB/GYNs, we can help mothers feel more confident and safer while exercising. This approach will encourage them to maintain an exercise routine throughout pregnancy, reducing the risk and severity of GDM diagnosis. Ultimately, our program aims to improve pregnancy outcomes for both mothers and babies by:

1. Lowering fasting and postprandial blood glucose levels

2. Decreasing the incidence of GDM

3. Reducing the severity of GDM in diagnosed cases

4. Promoting safer and more consistent exercise habits during pregnancy

The success of our program will contribute to better short-term and long-term health outcomes for mothers and their children, addressing the widespread impact of GDM.

Algorithm-based Personal Workout Recommendations to reduce pending complications

Our pipeline includes developing an AI-driven algorithm that provides personalized workout recommendations aimed at preventing conditions based on an individual's risk factors. For instance, users with elevated blood glucose levels would receive recommendations for more resistance-based exercises, as resistance training has been shown to improve insulin sensitivity more effectively than aerobic exercise. Additionally, for users at risk of developing gestational hypertension, the algorithm would suggest workouts with a greater emphasis on isometric exercises, as a metaanalysis of 270 randomized clinical trials published in JAMA last year showed that these exercises are most effective at reducing blood pressure. This novel technology has implications far beyond the pre and postnatal audiences as well. Our long-term goal is then to apply

this strategy beyond maternal fitness to treat any medical condition to become the pioneering leader in clinically proven, fitness-based medicine.

Virtual Doulas

Expect is prototyping a generative AI chat to answer the many permutations of users

questions based on the existing medical literature. Our ultimate goal is to implement a full-featured Virtual Doula that also offers proactive support and educational materials. With respect to PCOS, Doulas can play a helpful role in preventing gestational diabetes by providing education, and encouraging healthy lifestyle habits during pregnancy. 

Nutrition education: The Expect Virtual Doula can educate expectant mothers about the importance of a balanced, nutrient-rich diet and help them make informed food choices that can help regulate blood sugar levels and maintain a healthy weight during pregnancy.

Stress management: The Virtual Doula can interact with moms to determine stress levels and recommend Expect relaxation content, such as deep breathing, meditation, and yoga, to help manage stress levels. Chronic stress can contribute to insulin resistance and increase the risk of gestational diabetes.

Breastfeeding education: The Virtual Doula can educate and support mothers in establishing successful breastfeeding practices, as breastfeeding has been associated with a reduced risk of developing gestational diabetes in subsequent pregnancies.

Lifestyle coaching: The Virtual Doula can offer guidance on maintaining a healthy lifestyle during pregnancy, including recommendations for proper sleep, hydration, and overall self-care, which can contribute to better blood sugar control.

By offering comprehensive support and education, Virtual Doulas can empower expectant mothers to make informed choices and adopt healthy behaviors that may help prevent the development of gestational diabetes. This novel technology can be deployed for moms anywhere, any time.

AI-Driven Medical Reviews & Content Generation

Expect has achieved best-in-class safety by operationalizing a sophisticated medical review process wherein practicing OB-GYNs from independent hospital systems review and meticulously annotate each workout. As a result, Expect has thousands of minutes of doctor’s notes on workout content to train an AI model to vet new fitness content and even create novel fitness content with generative AI. 

Full Time: 2

Part-Time staff: 1

Contractors: 18

Dara Cook left MTV in 2022 to focus on Expect full time.

Diversity is in our DNA. Expect is black woman and LGBTQ+ owned and operated and this perspective imbues everything we do. The majority of our 16 OB/GYN advisors are women of color. They are all practicing physicians, and serve a broad racial mix of patients, heightening their sensitivity to diverse populations. Our doctors serve women with commercial insurance and Medicaid, giving them a perspective on the socioeconomic concerns facing women. 

Expect embraces diversity in front of and behind the camera and defies the current standard in which most sets in which content is filmed are dominated by men. Our LGBTQ+ Chief Fitness Officer prioritized gender balance behind the scenes and hired a woman as a Director of Photography. 

Our business model: Expect sells to employers,  providers, and insurers because maternal fitness reduces costs--saving payors an average of $3,000 per mom. Our subscriptions are $500 a year, delivering tremendous value. Incentivized by the reduction in costly complications that maternal fitness delivers, our enterprise partners funnel steady cohorts of moms to Expect. McKinsey also identified a direct to consumer opportunity for Expect which we successfully verified in a two-week test.

Expect has been vetted and funded by some of the most respected institutions in the world.

Investments from:

Laerdal Million Lives Fund $100,000 

Various Angels $317,235

Techstars Healthcare $20,000

Grant funding from 

Tiger Global Impact Ventures: $50,000 grant 

Harvard Business School Black New Venture Competition: $20,000 grant

Wharton Entrepreneurship Acceleration Program: $10,000 grant

McKinsey & Company consulting $3,000,000 value

Furthermore, as we have signed on our first payor, Point32Health, Expect has a pathway for recurring revenue from health insurers.