Pregnancy
Equity in maternal healthcare: femtech holds the key for rural hospitals
By Blanca Lesmes, CEO of BB Imaging and TeleScan

In the last 20 years, 184 rural hospitals in the United States have closed. Today, nearly 700 more of them stand at risk of closing. Of those that remain, less than half (45 per cent) provide labor and delivery services.
As a result, more than two million women of childbearing age live in a county completely devoid of obstetric care, and an additional three and a half million women live in a county with limited access.
The four sentences above stir a sense of sadness or anger in many of us. I appreciate my partners in progress, who acknowledge the depth of the maternal care problem and who are eager to build solutions that create a healthier future for our underserved family members, friends, and neighbours.
What won’t work
Let’s start with some “solutions” that I wholeheartedly reject.
I founded an onsite sonography services company nearly 20 years ago. At that time, rural hospitals and clinics were feeling the early pains of a sonographer shortage — a shortage that, today, has grown into a very real crisis.
The numbers of rural physicians, maternal-foetal medicine specialists, and nurses with obstetric experience have continued to dwindle dramatically over this time.
We’re left with thousands of healthcare vacancies that greatly exceed the number of professionals available to fill them (a difficulty my recruiting team works to overcome daily). So, sadly, the answer to our problem isn’t simply to “hire more people.”
Rural hospitals aren’t closing just because they can’t hire the right people, though. They’re closing because they can’t continue to operate at a loss.
Unfortunately, insurers usually pay for maternal services on a per-birth basis. This model works well for hospitals with high volumes of births per year but largely fails rural facilities.
Payments from a low volume of births throughout the year typically aren’t enough to cover operating costs for a rural obstetric department. If other service lines, like emergency and primary care, are also operating at a loss, the hospital has no choice but to close its doors permanently. These facilities are often patients’ last resort, so the answer can’t be to “allow unprofitable healthcare centres to close.”
Financially bolstering tech solutions
Although the system is inherently full of challenges, I do hold on to hope. Developments in femtech make me believe that real solutions are in the pipeline. We’ve seen these problems and responded with efficiency-supporting solutions like telemedicine, remote monitoring devices and AI.
Access to this depth and breadth of maternal-foetal support gives rural providers and their patients so many benefits.
Remote diagnostic tools, like TeleScan, provide an immediate connection to expert sonographers who can identify high-risk pregnancies and anomalies that require additional care. Remote monitoring devices provide round-the-clock data collection and can initiate care and expedite time to treatment.
With telemedicine, local providers can collaborate on treatment plans that keep their patients close to home, limit travel and financial stress, and create peace of mind. Through their exchanges, providers and remote experts also engage in knowledge sharing, building local expertise that enhances care levels for years to come.
AI-enabled tools increase efficiency and clear mundane, tedious, or repetitive tasks from staffer to-do lists. And they aid in patient communication, providing timely responses and assisting with scheduling tasks and documentation.
All these benefits—and there are so many more—are impossible without modern technology. Thankfully, the technology is there, and it’s getting better every day. It’s our responsibility to harness it and make it work for rural hospitals that are on the brink of closure.
The challenge we have to face
There is one last piece of the puzzle to discuss, and that’s the financial component. Our challenge is to make our technology affordable for the most vulnerable systems.
In a world where femtech is repeatedly undervalued, and funding is frustratingly difficult to procure, this is our challenge.
Finding the intersection of prosperity and purpose may impact the investment and attention maternity care requires. It’s up to us to find funders and founders who feel the same way we do.

Pregnancy
Women with pre-eclampsia at increased risk of chronic kidney disease, study finds

Women who develop pre-eclampsia face a higher risk of chronic kidney disease and high blood pressure later in life, new research suggests.
The amount of protein found in the urine during pregnancy may help identify those at greatest risk of developing long-term health problems.
Pre-eclampsia usually involves high blood pressure and increased protein in the urine. Some women also experience severe headaches and changes to their vision.
The condition cannot be treated during pregnancy and, in some cases, labour must be induced early to protect both the woman and baby.
The study found that the condition may be linked to longer-term health problems.
Anne Høy Seemann Vestergaard, a medical doctor and PhD at the department of clinical medicine at Aarhus University, said: “What we can see is a clear association between pre-eclampsia and the development of high blood pressure, chronic kidney disease and cardiovascular disease later in life.”
The researchers found that the amount of protein passed in the urine during pregnancy was linked to the risk of developing chronic conditions after giving birth.
Protein in the urine can indicate that the kidneys are not filtering blood normally.
Vestergaard said: “The most surprising finding was how clearly the amount of protein in the urine during pre-eclampsia was linked to the risk of later high blood pressure and chronic kidney disease. Women with moderate to severe protein excretion had a higher risk of both conditions compared with women with low or no protein excretion.”
Among women with pre-eclampsia and moderate to severe levels of protein in the urine, around one in 20 developed chronic kidney disease within 10 years and around one in six developed high blood pressure.
Most women in the study did not develop long-term complications, but the researchers said the increased risk should still be taken seriously because the potential effects can be severe.
Vestergaard said: “At first glance, this may sound like a low number, but it represents a markedly increased risk when the groups are compared. In the group with pre-eclampsia and high levels of protein in the urine, around 1 in 20 women developed chronic kidney disease within ten years, including early stages of the disease, compared with around 1 in 100 in the group with lower or no protein excretion.”
She added: “That is a considerable number in light of the fact that chronic kidney disease is a potentially serious condition that can progress to kidney failure if isn’t diagnosed early.”
The findings suggest women who experience pre-eclampsia may benefit from more systematic monitoring after pregnancy.
Vestergaard said: “Our study suggests that these women may benefit from monitoring of blood pressure and kidney function after pregnancy.”
Pregnancy
Pregnant women may reduce key health risk through more light exercise, study finds

Light exercise and less sitting may reduce pregnant women’s risk of serious blood pressure complications, according to a new study.
Researchers have proposed a daily activity and sleep guide that they say was linked to a nearly 30 per cent lower risk of hypertensive disorders of pregnancy.
The suggested pattern includes fewer than eight hours of sedentary time, at least seven hours of light physical activity, around 22 minutes of more intense activity and nearly nine hours of sleep.
The University of Iowa-led study examined the daily behaviours of 470 pregnant women across all stages of pregnancy.
Participants wore monitors that measured physical activity over 24-hour periods and recorded how long they spent asleep.
Hypertensive disorders of pregnancy include chronic high blood pressure, gestational hypertension and pre-eclampsia.
Gestational hypertension is high blood pressure that develops during pregnancy, while pre-eclampsia is a potentially serious condition involving high blood pressure and signs that organs may be affected.
Sedentary behaviour means being mostly inactive, such as sitting or lying down.
Light physical activity can include casual walking, moving around the home or standing.
Moderate to vigorous activity includes movement such as brisk walking, where breathing and heart rate increase.
Kara Whitaker, associate professor in the department of health, sport, and human physiology at Iowa and corresponding author of the study, said: “We are identifying the optimal composition of movement behaviours across the day associated with the lowest risk of developing HDP and the most improved health outcomes.
“This blueprint holds for each and every trimester of pregnancy.”
Study participants were enrolled at sites in Iowa City, Pittsburgh and Morgantown, West Virginia.
The women wore activity and sleep monitors for at least one week during each trimester of pregnancy.
Four in five participants were non-Hispanic white and nearly a quarter lived in rural areas.
The data showed a steep rise in risk among pregnant women who were sedentary for more than 10 hours a day.
Women who increased light physical activity to at least four hours a day reduced their risk of hypertensive disorders of pregnancy to 15 per cent from 30 per cent.
Whitaker said: “Just moving around more seems to have significant health benefits.
“And I think it also may be a more feasible target for women who are pregnant who are not exercising regularly.”
The researchers said they were surprised that longer durations of moderate to vigorous physical activity did not appear to provide additional benefit.
Sleep beyond a certain duration also did not appear to bring major further benefits.
Whitaker said: “Through this study, we are providing evidence that reducing sedentary behaviour and engaging in light physical activity are important, and maybe more important, when it comes to pregnancy and health.”
The findings may be relevant beyond pregnancy because clinical research has shown that women who develop hypertensive disorders of pregnancy are more than twice as likely to develop heart disease later in life.
Cardiovascular disease includes conditions affecting the heart and blood vessels, such as heart disease and stroke.
Whitaker said: “We know that cardiovascular disease is the number one killer of women, and if we can intervene in pregnancy and prevent women from developing a hypertensive disorder of pregnancy, we are putting them on a better trajectory, away from cardiovascular disease and toward more optimal cardiovascular health.”
The study was published online on June 10.
A second study, published online on May 27, looked more closely at the ratio and type of sedentary behaviour and light physical activity linked to a lower risk of hypertensive disorders of pregnancy.
Whitaker is a lead co-author on that study.
Co-authors in the June 10 study include Alex Crisp, Jaemyung Kim, Karina Smith, Donna Santillan, Mark Santillan and Bridget Zimmerman, from Iowa; Jacob Gallagher, from Iowa State University; Melissa Jones, from Oakland University in Michigan; Bethany Barone Gibbs, Katrina Wilhite, Alexis Thrower and Iqra Sheikh, from West Virginia University; and Sabera Rahman, Janet Catov, Christopher Kline and Maisa Feghali, from the University of Pittsburgh.
The National Institutes of Health, the University of Iowa Institute for Clinical and Translational Science, the University of Pittsburgh Clinical and Translational Science Institute and the West Virginia Clinical and Translational Science Institute funded the research.
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