A recently approved biomarker test can help pinpoint which patients are at highest risk for preeclampsia, which is one of the leading causes of maternal mortality in Georgia.
Champions of the test hail it as a life-saving tool that takes the guesswork out of identifying which patients are developing the hypertensive disorder that only occurs during and after pregnancy.
But access to the test may still be limited, partly because it is a relatively new tool in the United States. The U.S. Food and Drug Administration approved biomarker testing for preeclampsia last year, though the test has been used for nearly a decade in Europe.
State lawmakers passed a broad biomarker testing bill last year, but state Rep. Darlene Taylor, who says she had preeclampsia, sponsored a bill earlier this year that would have specifically required all health benefit policies in Georgia to cover biomarker testing for preeclampsia.
That proposal ended up stalling, but Taylor, who chairs the House committee overseeing spending on health services, said she made sure funding was put in the budget to cover the testing for Medicaid enrollees. Nearly half of child births in Georgia are covered by Medicaid, according to KFF Health News.
“I have been shocked at the number of women who have told me that they had it, and left untreated, it can be fatal for the mother but it can also hurt the baby,” the Thomasville Republican said in an interview. “So, I think it’s very important to do it.”
Offering the testing for state employees is still in the works, said a spokesperson for the Department of Community Health.
“While commercial payers may have determined preeclampsia biomarker testing is still investigational, our Georgia legislative partners have made this coverage commitment in the state’s Medicaid program,” said David Graves, the agency’s director of communications. “The state is evaluating a path forward for this coverage within the State Health Benefit Plan.”
Jesse Weathington, who is president and CEO of the Georgia Association of Health Plans, confirmed Friday that the test is still seen among commercial insurers as investigational for now, but he said that could change as more research is done.
“We’re going to follow the science, and if the science changes and this becomes something that is deemed efficacious by some of these (industry) groups, I think you’ll see the policy start to change,” Weathington said.
There were 30.2 maternal deaths for every 100,000 live births in Georgia from 2018 to 2020, which is the most recent report available from Georgia’s maternal mortality review committee. That represents about a 20% increase from the previous three-year period, when the rate was 25.1. Black women are twice as likely as white women to die from pregnancy-related causes.
Of the 113 pregnancy-related deaths during those three years, about 90% of them had some chance of being prevented, according to the committee’s report released last year. The 10 deaths attributed to preeclampsia or eclampsia were all ruled preventable.
Taylor argues the test also saves the state and insurers money in the long run by intervening when needed and preventing more advanced illness like stroke.
State Rep. Sharon Cooper, a Marietta Republican who chairs the House Public Health Committee, which advanced Taylor’s bill, said she sees the predictive test as a medical breakthrough.
“It will be a life-saver,” Cooper said.
The test isn’t meant for everyone, but in the situations where a patient is eligible, it can be a powerful tool, says Dr. Padmashree Chaudhury Woodham, who is a professor of maternal-fetal medicine at Wellstar Medical College of Georgia Health.
That’s particularly true as the maternal mortality rate has increased, due to factors like women waiting later in life to have children and increases in obesity.
“Not to scare people, but facts are facts, and I want people to realize why this kind of screening test is even more important now than ever,” said Woodham, who is also a member of the committee that reviews maternal deaths.
Being able to better identify which patients need intervention can help a woman’s lifelong health, potentially blunting the risk of other cardiovascular conditions and the need for other costly medical treatments later, Woodham said.
And the test results can also spare others the inconvenience and cost of unnecessary hospitalizations and the early deliveries that often lead to preterm babies and time in the NICU.
The test is available for patients who are pregnant with one baby and who are at least 23 weeks into the pregnancy. It’s also only approved right now as an in-patient test, which means the women are likely already showing signs of illness, and the patient must have already been diagnosed with a hypertensive disorder of pregnancy.
Woodham says the test is more accurate than the standard clinical measures currently being used to guide medical providers.
“It’s a test that really triages patients to determine who are the ones who are going to get sicker in the next two weeks, and that will then help the provider make a decision of how much surveillance that patient will need,” Woodham said.
Woodham said they are testing patients about two or three times a week at Wellstar MCG Health, which is acquiring the equipment to process the tests in house. She said that number will likely increase as awareness of the new test grows.
Nationally, about 16% of pregnant women have some form of hypertensive disorder of pregnancy and up to half of those will then go on to develop preeclampsia, Woodham said.
“I think the biggest hurdle right now is it is such a new test for the United States that a lot of doctors just don’t know about the test,” Woodham said.
Woodham said she encourages patients to ask their obstetrician about the test and whether they are eligible for it.
The availability of the test in the U.S. is long overdue, says Katherine Sylvester.
Sylvester, who lives in Macon, experienced preeclampsia after the birth of her second child in 2020. It was caught after her midwife noticed Sylvester’s blood pressure was elevated for her, though not by general standards.
Her personal experience inspired her to start an organization called Operation MIST that uses smart watches to monitor women’s health data before they are pregnant through the first year after delivery. Her program leans on lifestyle modifications to head off problems before they start and course correct along the way.
Sylvester, who is a physical therapist and doula, said the biomarker test can help empower mothers, though she does not know of anyone yet who has received the test.
“The more we know, the more we can do,” she said. “And I also think that sometimes we do know more, and nothing is done. But I feel like if we have access to this at least then providers can help moms make better decisions, and moms can make better decisions.”
But Sylvester said she would also like to see the testing help connect mothers with the support they need.
“That’s what I think the biomarker testing is doing is giving us more information, so that we — whether it’s the health care system or whether it’s our family unit, our community, the churches, people who want to do pro bono work, nonprofit organizations — we can support moms who need the support.”
This story comes to GPB through a reporting partnership with Georgia Recorder.
