By Megan Headley
U.S. maternal mortality rates continued their alarming upward trajectory in 2020. The Centers for Disease Control and Prevention (CDC) reported that the overall U.S. maternal death rate rose from 20.1 deaths per 100,000 live births in 2019 to 23.8 per 100,000 in 2020, an 18% increase. Between 2018 and 2020, pregnancy-related deaths increased by nearly 37%. Moreover, the CDC’s Maternal Mortality Review Committees determined that more than 80% of pregnancy-related deaths from 2017 through 2019 were preventable.
Despite this increasing rate of risk, many expectant mothers don’t know all the signs of the most common pregnancy-related complications. The Future of Pregnancy Health report, published in October 2022 by Mirvie and The Harris Poll, suggests that providing new and expectant mothers with more targeted education and tools to monitor their health can help to prevent common pregnancy-related risks.
Misunderstanding and misalignment
In its survey of 1,022 new or expectant mothers, the Future of Pregnancy Health report found that 59% of respondents said they didn’t understand certain aspects of their pregnancy care as much as they would like. This proved particularly true of younger moms between the ages of 18 and 24 (76%), compared to their older counterparts (55%).
While older mothers may feel more confident in their understanding, the report also highlighted an overall misalignment between this confidence and awareness of specific risk factors. For example, although 75% of survey respondents reported feeling that they had a good understanding of preeclampsia, only 10% were able to identify all of the common warning signs of preeclampsia correctly.
Dr. Allison Cowan, head of medical affairs at Mirvie and a board-certified OB/GYN, notes that her observation of this misalignment in practice prompted the surveyors to dig into this perception.
“It was interesting to see that anecdotal perception seem to be somewhat accurate,” she says. “Providers do a good job of talking with their patients about preeclampsia, and patients clearly feel that, but it’s probably not targeted enough. It may be that some of that pregnancy information just gets lost in the deluge of information that happens. Certainly, at the beginning of pregnancy, there’s a huge list of different aspects of pregnancy health about which we counsel patients.”
This is where Mirvie’s work is currently focused. The pre-commercial biotech company is developing an RNA platform that takes maternal blood samples 18-22 weeks into a pregnancy to evaluate the potential for developing preeclampsia. “From looking at differences in the RNA messages, we can see about 75% of patients who are destined to develop preeclampsia,” Cowan says. Differences in the RNA messages have also been used to detect who would go on to develop preterm labor in 76% of patients.
Cowan explains that these tools can provide a more targeted assessment of potential pregnancy risks to encourage women to proactively manage their health. “By predicting who is most at risk, you can then really personalize the discussion with patients to say, ‘You specifically have a higher risk of developing preeclampsia. It’s really important that you know the signs and symptoms of it.’ and reinforce that at multiple touch points over the course of pregnancy,” she says.
The value of more tailored care
Survey respondents in the Future of Pregnancy Health report shared that having more information about their pregnancy improved conversations with their healthcare providers (96%)—and encouraged them to speak up about concerns.
“Just as I as a doctor want to give my patients targeted and personalized education and a care plan, patients want to have targeted questions. They want to have a more personalized plan so that they can see, for their unique situation, what’s most important to look out for,” Cowan says. “I think that came through loud and clear in the survey results.”
Targeted education early on may also help improve medication adherence. The report’s survey respondents overwhelmingly reported (88%) that they would be more motivated to follow their provider’s medication recommendations if they better understood the risks of preeclampsia. This reporting is backed up by a number of studies on medication adherence, including a 2020 analysis determining that verbal educational interventions can improve health literacy and medication adherence among individuals with hypertension.
“Simple interventions, like taking aspirin, make a really big difference in development of preeclampsia when they’re used appropriately,” Cowan adds.
Detailed data for better prevention
While early identification of risks is critical for improving care, tools like the Mirvie RNA platform also seek to better understand the factors contributing to risks such as preeclampsia. Tools for more tailored care can gather more nuanced data to help researchers better understand the biological factors that elevate risk.
“We don’t fully understand yet in terms of why moms are getting hypertensive diseases and pregnancy so much more commonly than even 15 or 20 years ago. For me, that speaks to why we need to find a better predictive tool for preeclampsia so that we can find better ways to predict it, to personalize that care plan for moms, but then ultimately, hopefully, to prevent it,” Cowan says.
She adds, “What would be really exciting is that, over time, by understanding preeclampsia more from its biological underpinnings, we will eventually be able to help support the development of better therapeutics that could even more effectively prevent it.”