How science is individualizing pregnancy risks

Lindsay Orr was active and healthy, running marathons and hiking all around Colorado. During pregnancy, she developed a persistent headache and dangerously high blood pressure—hallmark symptoms of preeclampsia, a leading cause of preterm birth as well as maternal mortality and morbidity. She was induced at 32 weeks to save her and her baby’s life.

Now, two years later, she continues to experience the long-term impact of preeclampsia as Lindsay developed chronic high blood pressure, a condition she never had before pregnancy.

Pregnancy complications like preeclampsia, preterm birth, and fetal growth restriction are dangerous for mom and baby. These complications can strike without warning—sending pregnancies into a crisis overnight. For women like Lindsay who are healthy and don’t have risk factors for complications like preeclampsia, the experience is harrowing and surreal in what should be the most joyous time of a parent’s life.

It’s unacceptable for so many women, families, and doctors that the U.S. lags behind every major industrialized nation in addressing the maternal health crisis. It’s heartbreaking that 20% of pregnant women experience the crisis of a pregnancy complication. It creates trauma—long-term physical and mental health impacts on women—and also influences children’s health outcomes.

A prenatal model designed 100 years ago

As investment has lagged in obstetrics and pregnancy health, the prenatal care model for mothers’ health has remained largely unchanged over the past 100 years. Yet, rates of complications like preeclampsia continue to rise and preterm birth is at the highest level it has ever been in the U.S. We must understand what’s going on biologically in pregnancy to reverse these trends.

In the absence of biologically-driven approaches, overstretched and underresourced OB/GYNs and care teams have had to rely on generalized characteristics and demographics. Those include age, BMI, race, and socioeconomic status, to try to identify who may be at risk for pregnancy complications. The U.S. Preventative Services Taskforce guidelines define these as moderate risk factors.

Unfortunately, 80% of pregnancies have at least one of these moderate risk factors, making it a poor indicator of who is truly at high risk for preeclampsia. It’s no wonder that patients, clinicians, and care teams have little guidance on where to focus to create a personalized care plan to reduce preeclampsia risk. Some who have no risk factors end up developing severe forms of preeclampsia, and most with moderate risk factors have normal, uneventful pregnancies.

The status quo isn’t working. Women deserve better. Moms deserve better. Families deserve better. We need to understand the biology of women and their pregnancy journey if we want to make progress in understanding how to more precisely prevent, treat, and manage diseases that impact women.

A new era of pregnancy health

To create healthier futures for moms and babies, we need scientific advancements to better understand what’s happening in pregnancy so we can prevent crises caused by complications and preterm birth before they happen. This idea is not new, of course. Five-year survival rates for breast cancer went from a toss-up to around 90% once we brought to bear the scientific understanding of breast cancer’s molecular drivers.

Mirvie’s foundational, first-of-its-kind study uncovers insights we never knew about pregnancy. We examined the biology of nearly 11,000 diverse pregnancies from women enrolled across the United States and collected thousands of RNA transcripts and hundreds of clinical details from each patient, translating into millions of data points. Using this rich dataset, combined with advanced machine learning, Mirvie has identified unique molecular signatures to predict the risk of preeclampsia, preterm birth, and severe fetal growth restriction, months in advance.

What does this mean for clinicians? Physicians and care teams can move away from generalized risk factors and move toward a personalized care approach driven by a precision understanding of the disease. By identifying care plans and monitoring methods for the right patients at the right time, clinicians and care teams can create better outcomes for mom and baby.

Personalized medicine is the standard of care in fields like oncology and cardiology. Being able to finally understand which pregnancies are truly at high risk for complications based on one’s biology can allow women to plan ahead and do everything possible prevent dangerous complications like preeclampsia by adhering to evidence-based strategies like taking daily aspirin, monitoring blood pressure regularly, and incorporating lifestyle changes like diet and exercise. Then we can potentially prevent disease, near-death experiences, long NICU stays, and trauma.

With this type of information, we can shift toward personalized patient care and precision medicine by developing new, targeted therapies in the future. At a molecular level, we are closer to understanding who’s most at-risk for pregnancy complications and how biology impacts those at highest risk. Similar to the breakthroughs made in breast cancer in the 1990s, obstetrics can move towards a new standard of care steeped in biology, tailoring care and treatment based on the molecular characteristics of each pregnancy.

What gives me hope is that by finally being able to predict the risk of complications like preeclampsia, we can usher in a new standard of care that is preventive, and reverse course on the maternal health crisis.

Maneesh Jain is cofounder and CEO of Mirvie.

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