Thomas McElrath, MD, PhD, highlights limitations of current preeclampsia guidelines

In a recent interview with Contemporary OB/GYN, Thomas McElrath, MD, PhD, vice president of clinical development at Mirvie, discussed the limitations of current US Preventive Services Task Force (USPSTF) guidelines for assessing preeclampsia risk and the broader challenges in improving outcomes for pregnant women, especially Black women.

His study evaluated how well these guidelines work in real-world settings and suggested ways forward to improve preeclampsia prevention and treatment. McElrath emphasized that while the USPSTF guidelines were created with good intent using the best available data, their effectiveness in personalized care is limited. His study found that about 89% of pregnant women meet at least 1 moderate or high-risk criterion for preeclampsia.

This broad categorization may dilute the specificity of care and create ambiguity—if nearly everyone is considered at risk, it becomes harder to determine who truly needs intervention. This can undermine the goal of targeted aspirin prophylaxis and suggests that current criteria are too generalized.

To improve risk assessment, McElrath advocated for a shift toward biologically specific markers, rather than relying solely on clinical characteristics or demographic factors. He compared this to how cholesterol and HDL levels are used in cardiovascular risk assessment. For pregnancy-related complications such as preeclampsia, he pointed to the promise of cell-free RNA analysis, such as Mirvie’s platform, which can help stratify risk more accurately.

His team’s research suggests that preeclampsia is not a single condition but a spectrum of disorders with different biological causes—early-onset forms are linked to placental dysfunction, while later-onset forms involve immune activation and resemble gestational hypertension. Tailoring treatments to these subtypes could vastly improve outcomes.

On the issue of racial disparities, McElrath cautioned against interpreting race itself as an inherent risk factor. His data shows that when clinical risk factors are accounted for, race is not a predictive factor for preeclampsia. Instead, the higher prevalence of risk factors among Black women likely reflects systemic racism and social inequities. He emphasized the need to treat individuals based on their actual risk profile, not racial or social labels.

Finally, McElrath stressed that current approaches have not curbed rising preeclampsia rates, even as access to obstetrical care worsens in parts of the United States. He called for a proactive, biologically informed, and equity-focused strategy to address the growing burden of this serious pregnancy complication.

Disclosure: F. Hoffmann-La Roche AG.

Reference

McElrath TF, Jeyabalan A, Khodursky A, et al. Utility of the US Preventive Services Task Force for preeclampsia risk assessment and aspirin prophylaxis. JAMA Netw Open. 2025;8(7):e2521792. doi:10.1001/jamanetworkopen.2025.21792