At 32.9 deaths per 100,000 live births, the maternal mortality rate in the United States is egregiously high.
Even more troubling? Eighty-percent of those deaths are preventable.
Unfortunately, preventative care is notoriously underutilized in the U.S. healthcare system. Patients often fail to seek preventative care because of real barriers like cost and access, but in other cases it is just a question of mindset — the human brain is not wired to prevent problems, so much as to address them when they happen.
And providers do not have much incentive to reverse these mindsets. On their end, misaligned financial incentives actively discourage implementation of preventative services. Most providers, including hospitals and physicians, are paid to treat rather than to prevent disease.
The opportunity to change this paradigm lies primarily with payers, who have the potential to increase use of preventive services with value-based payment models and contractual requirements that include reporting on preventive health quality measures.
Fortunately, a shift from diagnostic to preventative care is gaining momentum in maternal healthcare. The silver lining of the current crisis has been an increased exposure of the contributing factors to poor maternal health outcomes, and urgency to fix the errors in the system — starting with the massive opportunity of preventable complications.
Preeclampsia is one of the leading factors in preventable maternal mortality. The only solution to preeclampsia is birth, but early detection of symptoms and identification of risk can massively decrease the instances of negative outcomes like preterm birth, or worse.
One of the most effective strategies toward management of preeclampsia is low-dose aspirin adherence after 12 weeks of gestation in pregnant individuals who are at risk. The US Preventive Services Task Force (USPSTF) initially recommended prophylactic aspirin for high risk individuals only, with ACOG and SMFM expanding that initial recommendation to include individuals with more than one moderate risk factor for preeclampsia.
These moderate risk factors are significant flags for long term problems, but hard to spot at an in-person appointment, as they often encompass non-clinical risk factors like lower income or underlying racism. In a study assessing aspirin adherence, many at-risk patients (as defined by ACOG criteria), did not recall recommendations to take aspirin for preeclampsia prophylaxis. Risks can go undiscovered for many reasons — lack of time in an appointment, patient discomfort at raising concerns, seeing multiple different doctors and providers over the course of pregnancy, absence of counseling — even a failure to understand what constitutes a risk.
Babyscripts has developed a care pathway within our mobile maternity program to circumvent some of these barriers and encourage patient adherence to low-dose aspirin, one of the most successful preventative care protocols for preeclampsia.
Through automated assessments that are delivered via the Babyscripts mobile app, patients can self-report their risk factors for preeclampsia, capturing data that they may be uncomfortable or unwilling to share with their doctor in person.
If a patient’s response indicates heightened risk for preeclampsia, they are automatically enrolled into low-dose aspirin adherence protocol, which includes an educational tool to inform patients of their risks, and reminders to discuss their risks with their provider and to take their medication.
With other risks as with preeclampsia, there is a massive opportunity to bring down the percentage rate of preventable deaths to near 0%. Technology can offer an effective pathway to that goal by supplementing existing infrastructure, as well as offering patients familiar and convenient solutions that seamlessly fit into their existing habits of being.
Want to learn more about maternal risk identification and opportunities for addressing preventable issues? Join us on October 25 at 3PM ET for Q&A and a panel discussion focused on risk identification in maternal health with payer, provider and quality perspectives.