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Addressing the US Maternal Health Crisis at Delfina

Senan Ebrahim, MD, PhD
CEO at Delfina
09 Sep 2022 · 7 min read
US maternal health crisis

Pregnancies are often thought of as both a time of change and a time of reflection. Families may reflect on the profound psychological, physical, and social changes that a pregnancy can bring as they prepare to welcome a new family member. Pregnancy-related healthcare often brings another set of changes for patients and their families. Families are increasingly concerned by the inherent risks of pregnancy, which are impacted by biological, social, and environmental stressors. The rates of adverse outcomes for moms and babies have now worsened to constitute a global maternal health crisis (WHO Global Health Observatory).

The risks of pregnancy are particularly apparent in the United States, which ranks 55th among global nations for maternal mortality (CIA World Factbook). As of June 2022, the White House has established that we are in a national maternal health crisis, in turn necessitating a national response. The risks of pregnancy are not only generally elevated, but are also particularly acute for people of color: in 2018, the overall maternal mortality rate was 17.4 deaths per 100,000 live births, and up to 37.3 for Black women (CDC NCHS Health E-Stats) and 29.7 for American Indian/Alaskan Native women (Heck et al. 2021). Recent evidence suggests that these risks are worsening. As of 2020, the maternal mortality rate has since increased to 23.8 maternal deaths per 100,000 live births overall and 55.3 maternal deaths per 100,000 live births for Black mothers (CDC NCHS Health E-Stats). It is becoming increasingly risky to be pregnant in the United States compared to nations with advanced economies, despite our significantly higher pregnancy-related healthcare spending (Petersen et al. 2022).

The picture for infant mortality in the United States is equally concerning. In 2017, there were 5.17 infant deaths per 1,000 live births, placing the United States behind 53 other nations ranked (CIA World Factbook). This number is similarly on the rise. In 2021, the infant mortality rate increased to 5.6 infant deaths per 1,000 live births, and for Black infants the rate is nearly double at 10.9 (March of Dimes Report Card). This disparity in pregnancy health, despite high expenditures, persists across other metrics, including access to prenatal care and outcomes like preterm birth.

Existing solutions have failed to meaningfully improve these worsening maternal and neonatal outcomes. Equitably addressing the maternal health crisis in the United States will require an intervention that empowers patients and providers alike by enabling preemptive action for complications of pregnancy. This intervention would need to simultaneously reduce healthcare costs for all stakeholders, while limiting administrative burden for healthcare providers. It would also need to simplify the experience of both providing and receiving pregnancy care, allowing patients and providers to spend their time together efficiently, while concurrently optimizing health outcomes. A solution that can achieve all of these goals would specifically and directly address racial disparities in healthcare delivery and outcomes.

This is exactly what we built Delfina Care to do. Delfina Care is a pregnancy care solution built around our machine learning-based risk prediction technology. We believe that empowering care teams with personalized, data-driven risk profiles of their patients will support delivering better pregnancy care and ultimately better outcomes.

Delfina Care facilitates patient engagement through a user-friendly app featuring personalized educational content in multiple languages, data collection from remote monitoring devices, and on-demand virtual support from a multidisciplinary care team. Patient data in Delfina Care is analyzed for the sole purpose of generating machine learning-based risk scores, which in turn support providers in optimizing care.

With Delfina Care, providers have continuous access to clear insights about their patients’ pregnancy risks. Delfina Care augments providers’ workflows and helps them more efficiently allocate their time. As previously demonstrated by the OB Nest program, patients with certain risk scores may need more hands-on care, more frequent visits and monitoring, and earlier intervention to prevent adverse pregnancy outcomes. Patients with lower risk scores might be eligible for at-home monitoring and decreased frequency of in-office visits, relieving time burdens for both patients and providers without any significant change in outcomes (Butler Tobah et al. 2019).

Delfina Care’s predictive models directly address the racial and ethnic disparities in pregnancy care. Our model for predicting hypertensive disorders of pregnancy (HDP) during the first trimester outperforms the existing risk guidelines from the American College of Obstetricians and Gynecologists (ACOG), and was designed and tested specifically to perform equitably across racial and ethnic groups. Delfina’s dynamic risk prediction model correctly predicted 18% more cases of HDP in the first trimester than ACOG risk guidelines, with equitable performance in all racial and ethnic groups (Kadambi et al. 2022). Better risk prediction enables HDP cases to be flagged for providers earlier, improving treatment plans and results. For example, earlier identification of patients at high risk of developing HDP has been shown to yield benefit from mitigation strategies such as prophylactic use of aspirin, closer interval surveillance, and timed delivery (Garovic et al 2022).

Delfina has also developed machine learning models for predicting risks of other preventable conditions that have a high impact during pregnancy. We understand that when providers have appropriate insights to provide individually tailored care, patients are more likely to experience a well-supported pregnancy with better outcomes. That’s why we created Delfina Care to support providers in understanding patient risk earlier and more comprehensively.

Delfina Care also provides a full suite of services for pregnant mothers to directly empower their pregnancy journey. The goals of the Delfina App and connected services, including monitoring and telehealth, are twofold. First, they help pregnant patients navigate their journey with educational materials and daily best practices, mitigating the anxiety that may accompany the pregnancy experience. Second, Delfina brings care to pregnant patients where they are. Patients are monitored from the comfort of home, replacing infrequent, lengthy and one-size-fits-all clinical visits with frequent, simple, and asynchronous knowledge transfer with multidisciplinary care teams. Combined with on-demand integrated provider visits, these workflows help reduce provider burden and ultimately strengthen provider-patient relationships.

Delfina Care is now positively impacting the lives of pregnant patients in the United States, with the goal of improving outcomes for all. We are excited to be working with innovative health plans that are making Delfina Care accessible to their members. By adopting Delfina Care, our partners improve pregnancy outcomes equitably, reduce costs of care, and provide a cutting-edge personalized care experience to their pregnant members.

At Delfina, we believe it will take a village to solve the maternal health crisis in the United States. We welcome you to join us.

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