Recommendations for high-risk expecting parents and health care providers to promote the prevention of preeclampsia, a leading cause of pregnancy-related death in the United States
SAN FRANCISCO – April 28, 2023 – A new special report published in the American Journal of Obstetrics and Gynecology (AJOG) provides a groundbreaking approach to preeclampsia, one of the most pressing issues in maternal health today, and will translate the prediction of risk into prevention of disease.
The report, “Care plan for individuals at risk for preeclampsia: Shared approach to education, strategies for prevention, surveillance and follow up,” provides specific recommendations for both expecting parents and clinicians. The Care Plan’s recommendations include consideration of daily low-dose aspirin, surveillance, behavioral strategies, patient and provider education, addressing social determinants of health, and long-term follow up. These recommendations are a significant shift from the current care approach, which has historically lacked a comprehensive, integrated strategy. While technology to reliably predict preeclampsia is imminent, until now there has not been clear direction on optimal strategies for its prevention.
A leading cause of pregnancy-related deaths in the U.S., preeclampsia is a disorder of high blood pressure that can result in preterm birth, organ damage, and other severe complications during pregnancy. The impact of preeclampsia can extend across a lifetime for both moms and babies. With maternal mortality rising in recent years and high blood pressure disorders in pregnancy (including preeclampsia) doubling since 2007, there is an urgent need to predict, prevent, and mitigate its devastating impact.
Fortunately, there are several effective interventions that have been associated with reduced risk of preeclampsia in individuals at increased risk. The new AJOG report synthesizes them all into an objective, evidence-based recommendation for the first time and provides checklists for both individuals at risk and health care providers, which can be downloaded and shared. Today, most pregnant individuals at increased risk do not receive even one of the interventions to prevent preeclampsia. For example, less than half of high-risk patients receive low-dose aspirin. By streamlining the evidence-based recommendations into a straightforward Care Plan, the report systematically outlines the multi-pronged preventive approach that patients at risk should be receiving, which includes:
- Key recommendations for health care providers: Risk assessment including social determinants of health, pharmacological recommendations (including aspirin therapy and antihypertensive therapy), and behavioral recommendations (including specific information about diet, exercise, and sleep)
Key recommendations for persons at-risk for preeclampsia:
- To discuss with a health care provider: Questions regarding aspirin use, exercise during pregnancy, blood pressure monitoring, and more
- To do on their own: Watching for signs of preeclampsia with symptoms listed, checking blood pressure at home and reporting any readings greater than 140/90, implementing dietary, exercise, and sleep changes, and more
“This new comprehensive Care Plan, developed by a diverse group of preeclampsia experts, payers and advocates is a specific and clear set of recommendations based on peer-reviewed evidence and expert opinion,” said James Roberts, M.D., a Maternal-Fetal Medicine researcher at the Magee-Womens Research Institute, UPMC and founding Principal Investigator of the Global Pregnancy Collaboration who is one of the lead authors. “The plan outlines medications, monitoring, behavioral modification, education, and considerations for social determinants of health. It is designed to be as safe, cost-effective, and practical to implement in real world practice as possible. The clear checklists further encourage their use for any pregnancy considered to be at increased risk for developing preeclampsia,” added Dr. Roberts. He said the team intends to have these checklists translated into multiple languages to further improve access and use.
”Objective prediction of preeclampsia risk months in advance will soon be possible, and the Care Plan answers the question of what to do with that information,’” said Alison Cowan, M.D., M.S.C.R. and Head of Medical Affairs at Mirvie. “An unprecedented collaboration between medical experts and preeclampsia advocates created this novel patient-centered Care Plan. It represents a critical step in preventing preeclampsia and saving lives.” Mirvie, a company developing the first platform to predict pregnancy complications by revealing the underlying biology, supported the independent development of this report to contribute to an increased understanding of how to prevent preeclampsia.
Eleni Tsigas, CEO of the Preeclampsia Foundation and one of the co-authors noted, “By centering preeclampsia survivors as experts and co-authors, alongside clinicians, researchers, and payers, we have produced a practical and proactive comprehensive Care Plan. It is written in clear and simple language, can be easily incorporated into electronic health record (EHR) systems, and is designed to be a cooperative plan for both women and their care teams. With consistent implementation in any setting, we expect this Care Plan will help address inequalities in maternal care.”
With objective, predictive testing for preeclampsia imminently on the horizon, this integrated Care Plan will translate risk prediction into disease prevention. As many women without traditional risk factors will still develop preeclampsia, this combination of novel predictive and preventive tools will prove to be indispensable for all clinicians and patients seeking to prevent this serious pregnancy complication and the lifelong health impacts of preeclampsia.
Mirvie is shaping the future of pregnancy health by providing women, expecting parents and their doctors with an early detection window to intervene before unexpected pregnancy complications become a crisis. One in five pregnancies is impacted by complications that lead to lifelong health consequences for expecting parents and babies. The proprietary Mirvie RNA platform uses a simple blood test to reveal vital information about a pregnancy’s unique biology and detect complications months before they occur. The idea for Mirvie was sparked by the personal experience of one of the founders whose daughter was born prematurely. Mirvie’s team of world-class scientists and entrepreneurs have brought to market category-first, non-invasive tests in both women’s health and in early cancer detection, used by millions today. Founded in 2018, Mirvie has raised more than $90 million in early-stage financing from top-tier investors, including Decheng Capital, Foresite Capital, General Catalyst, GV, Khosla Ventures, and Mayfield. Mirvie is based in South San Francisco, California. To learn more about Mirvie, please visit www.mirvie.com.
About Global Pregnancy Collaboration
The Global Pregnancy Collaboration (CoLab) is an international consortium of 40 centers. CoLab promotes collaboration in pregnancy research to improve maternal and child health worldwide. This is accomplished by assisting collaboration and sharing of data and biological samples, and education with special attention to developing research infrastructure in low-resource settings. Efforts address the needs of all maternal child health care—from the simplest in the most resource-poor countries to the most sophisticated research in more privileged areas. For more information, visit https://pregnancycolab.tghn.org.
About Preeclampsia Foundation
The Preeclampsia Foundation is a U.S.-based 501(c)(3) non-profit organization established in 2000 to improve the outcomes of hypertensive disorders of pregnancy by educating, supporting, and engaging the community, improving healthcare practices, and finding a cure. We envision a world where preeclampsia and related hypertensive disorders of pregnancy no longer threaten the lives of mothers and babies. For more information, visit www.preeclampsia.org.
American Journal of Obstetrics and Gynecology
Method of Research
Subject of Research
Care plan for individuals at risk for preeclampsia: Shared approach to education, strategies for prevention, surveillance and follow up
Article Publication Date
Funding was provided to The Precia Group (Precia) and the Global Pregnancy Collaboration (CoLab) to assemble this care plan by Mirvie, Inc., who are developing a biochemical predictor for preeclampsia. Precia and CoLab used a portion of these funds to support the time of some of
the authors. Mirvie had no part in selecting authors or in the content of the manuscript which they did not see until after submission for publication.
IMB, JRB, FLF, AH, ADG, CRG, and TP, received an honorarium for participation in the Working Group that developed the Care Plan for Individuals at Risk for Preeclampsia. AJ and EFS are site PIs overseeing sample collection on a Mirvie project. The remaining authors report no conflict of interest.