A 26-year-old Stanford grad student created a simple test to predict which pregnancies are likely to become premature deliveries

• Mira Moufarrej invented a blood test to predict preterm delivery up to two months before birth.
• The PhD student also created a test to preditc preeclampsia in the first rather than third trimester.
• The RNA tests could redefine prenatal care, prevent serious complications, and save lives.

Preterm labor is hard to predict. One minute a mom-to-be could be launching a work project or planning a weekend trip, and the next she's struck with contractions and in need of urgent care.

The consequences can be dire: preterm birth is the leading cause of infant death, and surviving preemies can develop short and long-term complications including those affecting the lungs, heart, and brain.

But Mira Moufarrej says it doesn't have to be that way. The 26-year-old Stanford bioengineering graduate student developed simple blood tests that identify pregnancies at risk of preterm birth, as well as preeclampsia, accurately and early. In April, the invention won her $15,000 as a recipient of the 2021 Lemelson-MIT Student Prize.

She hopes the tests will lead to far fewer medical complications, costs, and lives lost - especially among Black women who are at higher risk for both preterm birth and preeclampsia.

"These blood tests can empower mothers with concrete data to more strongly advocate for themselves during pregnancy and seek appropriate medical care early," Moufarrej told Insider.

Doctors usually 'just guess' if a baby will be premature

Currently, doctors use tools like ultrasounds to monitor a person's pregnancy, but those only provide a snapshot of what's going on and don't foreshadow what's to come.

Doctors "just guess" which babies may arrive preterm, Dr. Michael Elovitz, director of the Maternal and Child Health Research Center at the University of Pennsylvania, said in a fact sheet.

One of Moufarrej's blood tests, however, can predict preterm birth up to two months before delivery, which can allow clinicians and patients to be proactive. For example, doctors may issue medications to speed up the fetus's development or attempt to delay the birth, and the mom-to-be may change where they plan to deliver.

"It allows them to be aware that this is something that may happen," as opposed to suddenly experiencing contractions and needing emergency care, Moufarrej said. "For mothers who don't live close to hospitals with excellent NICUs, that can prove extremely difficult and may result in loss of life."

Another of Moufarrej's tests helps doctors and patients also get ahead of pre-eclampsia, a potentially deadly high-blood pressure condition that affects 1 in 20 pregnant people and even more Black patients. Right now, the symptoms - including weight gain and headaches - are easy to dismiss as the normal discomforts of pregnancy, and some patients don't have symptoms at all.

If it does get diagnosed, it's typically during the third trimester, but Moufarrej's test can detect it in the first - allowing providers to prescribe low-dose Aspirin, which can help prevent the condition altogether.

"That's especially important for Black mothers in the US who are three to four times more likely to die during childbirth," Moufarrej said. "Altogether these tests empower mothers to take control of their own healthcare in a system that is imperfect."

The invention builds on years of work

After a clinician takes a routine blood draw from a pregnant patient, Moufarrej's tests work by measuring cell-free messenger RNA, which is a portion of the blood's plasma.

Unlike DNA, which can only measure static aspects of a pregnancy like chromosomal abnormalities, RNA changes over time and so reflects how the fetus is developing.

But finding the right subset of RNA molecules out of thousands was not easy, and something scientists have been working on for years.

Moufarrej's invention, which involved collaboration with other engineers, scientists, and obstetricians, "is like most science, it's incremental and it builds on itself," she said. "You need to have the technology. You need to have an information source. And then you need to see if that information source contains useful information from the clinical context."

The tests could be available in the next few years

Now, the tests are being tested in women all over the world to make sure they provide clear and accurate answers for real patients. Researchers will see how well the tests' predictions match up with real-world outcomes.

Meantime, Moufarrej has patented both tests and the prenatal predictor has been licensed by the startup Mirvie, which she built with her doctoral advisor. The preeclampsia test is expected to be licensed next. Both tests, she said, should be available on the market in the next few years.

And they'll be affordable: While most prenatal tests cost $800 to $3,000 each, typically covered by insurance, Moufarrej's are expected to be under $100 since they use a much cheaper technology.

Her team expects insurance companies to cover them since the costs of the preterm deliveries are far greater, and there's already a billing code to process such tests.

Dr. Stephanie Ros, an OB-GYN and maternal-fetal medicine specialist at the Universtiy of South Florida, told Insider she thinks Moufarrej's tests "have the potential to make a huge difference," but has some hesitations.

For one, as Moufarrej acknowleged, before such inventions go mainstream, it needs to be clear the benefits of the tests outweigh the risks, like false positives that can lead to unnecessary anxiety or interventions.

"There are many labs around the country who have been working on looking at molecular prediction methods for both preterm labor and preeclampsia, with mixed results," Ros said. "I'm cautiously optimistic that this new approach using molecular genetics will be more accurate, but I think we are a very long way - as in, many years - from this being used in widespread clinical practice."

Moufarrej first wanted to be a doctor

When Moufarrej began this work, she was in her early 20s and pregnancy was far from her mind. But she'd always been driven to diagnose medical complications early, first thinking she wanted to be a doctor after her grandmother died from pancreatic cancer that was diagnosed too late.

"As I learned more, I learned that it wasn't just cancer that had this problem, many areas of healthcare, and specifically women's healthcare, were understudied," she said.

Moufarrej was also motivated by strong female role models. Her other grandmother, for example, lived through the Lebanese civil war - taking over the family business when her husband died and putting her children through college along the way.

Now, at 26, Moufarrej is owning her own strength as a scientist. "Seeing myself as a scientist has evolved over time," she said. "Winning this award has been great validation there that I am an inventor and a scientist, and I'm really excited to be a part of the program."