Preeclampsia affects roughly 5-7% of pregnancies worldwide. In the United States, the rate of hypertensive disorders of pregnancy (high blood pressure caused by pregnancy) has nearly doubled since 2007. Preeclampsia is a common and severe type of hypertensive disorder of pregnancy. Preeclampsia can lead to complications for mothers and their babies during or immediately after pregnancy, and has been linked to the development of chronic disorders for both moms and babies later in life.
When someone develops preeclampsia during pregnancy, the most effective treatment is delivery – which may result in preterm birth, which is accompanied by its own set of complications. As such, leading medical organizations and researchers have emphasized the importance of preventing preeclampsia through initiation of evidence-based interventions early in pregnancy. At Delfina, we are building predictive models that use electronic health record (EHR) and remote patient monitoring data to help identify patients that might benefit from these early interventions. With earlier application of evidence-based interventions, we can reduce the rates of preeclampsia and create healthier outcomes for moms and babies.
What are evidence-based interventions that prevent preeclampsia?
The American College of Obstetrics and Gynecology (ACOG) recommends “low-dose aspirin (81 mg/d) prophylaxis after 12 weeks of gestation in pregnant individuals” to lower the risk of preeclampsia in at-risk individuals. In addition, a recent meta-analysis found that calcium supplementation, low-molecular-weight heparin, vitamin D supplementation, and exercise may also be effective. However, it is still unclear which patients will benefit the most from each intervention. For example, another recent meta-analysis found that prophylactic low-dose aspirin was not associated with lower risk of preeclampsia diagnosis among patients who have chronic hypertension prior to pregnancy. As this is likely not a one size fits all solution, additional research is needed to identify which intervention (or combination of interventions) work best for specific patients.
Who should receive these evidence-based interventions?
ACOG has a checklist risk criteria for identifying at-risk patients that would benefit from prophylactic low-dose aspirin. This consists of 14 risk factors that should be available in a patient’s EHR. However, recent research has shown that the checklist is difficult for providers to apply in practice due to inconsistent documentation of risk factors in standard EHRs. Further, the ACOG checklist is typically applied during the late first trimester and only renders a single snapshot of the patient’s risk using pre-pregnancy information. Apart from the ACOG guidelines, no other risk criteria are readily applied in obstetric practices to identify patients that may benefit from monitoring or other types of interventions.
How is Delfina helping?
Delfina is supporting providers to identify patients that may benefit from various evidence-based interventions. First, we collate data from patients’ daily at-home symptoms on our provider dashboard to enable providers to quickly identify patients that would benefit from lifestyle interventions known to reduce the risk of hypertensive disorders of pregnancy. This allows providers to monitor their patients’ symptoms more continuously than traditional prenatal visits allow. Second, we support patient adherence to interventions selected by the provider. For example, if the provider has recommended the patient initiate prophylactic aspirin, our patient app and Delfina Guides would encourage patients to engage with their providers’ recommendations. Third, if the provider initiates at-home blood pressure monitoring, we equip the patient with a connected blood pressure cuff so that providers can have more insight between in-person visits. Fourth, we are actively conducting research to evaluate interventions, identify barriers to intervention uptake, and understand patient experiences with our hypertension-related workflows. All of this enables us to support providers to better deliver care to their patients.
If you want to learn more about initiatives to support preeclampsia survivors, we recommend visiting the Preeclampsia Foundation website! If you’re interested in learning more about our team’s research, join us here.