With many headlines in 2022 bringing concerning updates on the state of pregnancy health, it may be difficult to imagine a positive future for 2023. Indeed, with the U.S. maternal mortality rate being the highest among industrialized nations1 and the recent news that over 80% of pregnancy-related deaths are preventable2, the stakes are higher than ever, as are the challenges faced by expecting parents and their care teams.
But there is room for hope: with the increasing investment in pregnancy health research in recent years, fundamental insights revealed by new technologies, and a broader role for digital health, meaningful change is on the horizon. We see that there is a strong appetite for change, as well as unprecedented resources for effecting it. Increased investment is being driven by high growth expectations for the women’s health market, forecasted to grow from $18.8B in 2019 to $60B in 2027.3 Now is our time to accelerate the momentum, to build on these investments, and to reimagine the future of pregnancy health.
What’s most likely to change for pregnancy health in 2023? Mirvie is focused on three critical areas of innovation and progress in 2023 and beyond.
We’ve seen incredible progress in the field of personalized medicine in general, representing over 40% of the FDA’s newly approved drugs in 2018.4 In the field of oncology, personalized care has become the standard of care and is the expectation.
While oncology has historically taken the lead in personalized care and precision medicine since the late 1990s, other areas of medicine could greatly benefit from this medical model.5 Pregnancy health is one such area, finding itself at a critical inflection point in terms of the opportunity, and the unmet need, for evolution in personalized care. Despite nearly 4 million births annually in the United States,6 we’ve seen slow progress in the field to better understand some of the biological causes of even the most common complications in pregnancy, such as preeclampsia and spontaneous preterm birth.
Historically, we have failed to predict and prevent many complications in pregnancy because they are complex and multifactorial, and there has been insufficient investment to understand the biological causes. Where conditions have simpler causes, we’ve seen substantially more progress in screening. Consider group B strep infection: we have known for many years that moms who are colonized with this common type of bacteria have an increased risk of transmitting the microbe to their babies during birth, and rarely, group B strep can cause serious infections and death in newborns. Initially, risk-factor-based screening was used, in which some moms were given antibiotics in labor to protect against neonatal infection. But this was ultimately found to be ineffective, leading to a transition to universal screening.7 This was possible in part because screening for a single organism is much simpler than predicting complications with more complex etiologies, and is another reminder of the pitfalls of screening based on risk factors.
So what’s new in 2023? Why can we now hope to predict complex but comparatively common complications in pregnancy? Fortunately, recent advancements in genomics and machine learning make it possible to finally understand the underlying biology of pregnancy and its complications. Mirvie’s RNA platform allows the development of tools to do just that, by analyzing thousands of RNA messages that can reveal critical information about each pregnancy’s progress and potential future complications.8,9
Pregnancy health is poised for personalization in early detection of disease, enabling more individualized pregnancy health care and, eventually, therapeutics tailored to the underlying biology of pregnancy. The technology Mirvie is developing will be able to offer moms and expecting parents a roadmap for their future. And by knowing their personal risk of preeclampsia, preterm labor, and potentially other complications, expecting parents will be able to plan for their road ahead, doing everything possible to prevent these complications from occurring.
An unexpected benefit of the COVID-19 pandemic has been the rapid rise and implementation of telehealth. Out of necessity, many healthcare providers began offering telehealth services when the pandemic started and have continued to provide those services due to ongoing demand. For pregnancy health, early data suggests that telehealth provides comparable outcomes to traditional models that are nearly a century old and leads to improved patient satisfaction and engagement.10
With the widespread availability of digital and telehealth services, we can expect that traditional pregnancy healthcare will undergo substantial revisions in 2023. The rise of digital health platforms, in which we’re seeing women seek medical care outside of the traditional model, tells us that consumers want the rapid, personalized, and convenient care that digital health can provide. In addition, the major professional society for OB/GYNs also sees a need for change, having announced upcoming recommendations to move away from the conventional in-person visit schedule, lamented by some as being ‘one size fits none,’11 to a personalized plan of care tailored to each woman’s unique needs.12
This new pregnancy health model will focus on early risk stratification in pregnancy, which will then set the course for the remainder of each woman’s care. What are her underlying medical conditions? What medical risks does she have? What social factors are potential barriers to her receiving the care she needs? And what are her values and preferences regarding in-person care, virtual care, or a combination?
This unprecedented shift in care will allow each expecting parent to receive a personalized care plan tailored to their unique needs. In combination with #1 above, pregnancy health in 2023 is poised for change that will result in healthier moms and babies, and improved efficiency and care delivery across the board.
While other areas of medicine have started to routinely implement remote patient monitoring, such as home blood pressure monitoring13, this has been slow to take off in obstetrics. In combination with the plans for revising the prenatal care schedule, we anticipate that remote patient monitoring will find a more prominent place in pregnancy care in 2023.
There is substantial interest in whether home blood pressure monitoring during and after pregnancy can improve outcomes, and so far, there have been some encouraging results reported in the literature. A recent systematic review and meta-analysis found that home blood pressure monitoring in pregnancy was associated with a 45% reduction in inductions of labor, a 70% reduction in prenatal hospital admissions, and a 50% reduction in the diagnosis of preeclampsia.14 While further study is needed, these results are certainly encouraging.
In combination with the changes to the pregnancy care model we’re likely to see in 2023, remote patient monitoring will take a more prominent role in the coming months and years. While this is likely to start with the technologies currently widely available, including blood pressure monitoring and glucose monitoring, some are working on technologies that will even allow monitoring of fetal wellbeing at home. When we make remote patient monitoring easy and accessible for all, broader implementation of these simple measures stands out as a game changer for pregnancy health.
Imagine a new vision of pregnancy care: You find out you’re pregnant using an at-home test and call your doctor or midwife. They meet with you one-on-one, discussing your questions, fears and hopes, and your medical history. In addition, they assess any barriers you may have to receive care. If it is difficult for you to take time off from work for appointments, if you have transportation issues, or if you simply prefer to have as much care from home as possible, you make a plan to achieve that together. In fact, you only need to come to the office in person about four times during the entire pregnancy and can complete the rest of your visits virtually if you’d like to.
After receiving an innovative, simple blood test, you are told you have an increased risk of developing preeclampsia in your pregnancy. Your care team reviews what signs and symptoms to look for, recommends that you start taking a baby aspirin every night, and prescribes a home blood pressure cuff for you to keep a closer eye on your blood pressure. You feel like you have a plan and can enjoy your pregnancy, reassured that your care team is vigilant and that you’re being proactive. Your care team reviews your elevated blood pressures in real-time, ensuring timely evaluation for any changes in your health.
This is not the pregnancy care of 2022, but it can be the pregnancy care of the future. With momentum building and new technologies on the horizon, patients will finally receive the personalized care they need and deserve. Women will be able to develop a care plan in partnership with their doctor or midwife that is unique to their underlying biology, and tailored to their individual social needs and values, enabling optimal prevention of complications that they are at particular risk of experiencing. At Mirvie, we work every day to bring this vision of pregnancy health to fruition. We can’t wait to see what the future holds.
