Revolutionizing Maternity Care: Ann Holder's Vision for AI-Monitored Pregnancy with MARANI

My company is Marani Health. We developed a whole new device for maternal and fetal monitoring during pregnancy. It came from a project I was working on with the Mayo Clinic. I was asked to join them to work on this project by a group of cardiologists, electrophysiologists specifically, and then some OBGYNs and engineers to try and advance fetal and maternal monitoring, just because the technology was so antiquated. I actually left the technology, a few different prototypes, and then we spun the company out of Mayo.

If you think about cardiology and how EKGs are taken, they use biopotential electrodes to capture electrical signals for the baby and the mom, and the electrical signals for the uterus for contractions. The future of it, and this is where it gets really exciting, a lot of the early development of neural networks or machine learning for ECG signals was pioneered at Mayo with Dr. Paul Friedman and his team. They've used machine learning to assess the signature of that ECG for changes, so that you know when there's a change that could be problematic. What we wanted to do was take some of that technology and use it for fetal monitoring, but the first thing we had to do was develop a device where we could actually capture the fetal ECG and the maternal ECG, which had never been done until now. There are a couple of devices that use ECG signals that are cleared for hospital use, and a couple have been cleared for home use. But we truly believe with the technology we have and the patents, we're going to be able to get really good, consistent, clear ECG signals so that we can use machine learning.

It's really interesting and actually really depressing. When I was first asked to do this, I did my own research to understand what the issue was, was there a market. I was embarrassed to find out how awful it was. As somebody who's worked in medical technology and has had four kids myself, there's been little investment in new technology for maternal monitoring. In women's health in general, it's a systemic problem. What I found was highlighted by organizations like the March of Dimes and the CDC: rural hospitals are closing OBGYN services across the country at a staggering rate. Interestingly, it's happening in rural areas but even in metropolitan areas, hospitals are closing those services. So women's access to care is going down significantly while our maternal and fetal outcomes continue to get worse.

Yes, I agree with you. I think that you're one of the trailblazers. We've had enough, and this stops with us. You're going to save a lot of lives with this.

Exactly. It was really interesting talking to a maternal fetal medicine physician. There's a group of clinicians out there who aren't embracing the technology, but she said we have to move forward, we cannot stick our heads in the sand any longer. So I think there's hope and promise for the future. It's just going to take time and money. Getting investors in women's health is difficult. As much as it's in the news right now, the fundraising is really hard for us.

Very good point. The other thing I wanted to ask you about is everything the company offers. I know you offer an entire platform of healthcare. What does that look like?

The device is for hospital use, primarily in labor and delivery, so that moms and physicians have better knowledge and understand when a baby is truly in distress. But my background was in chronic disease management in the home, and I knew there was a place for this. I'm passionate about digital health, so part of the company's strategy was to take this into the home. I remember talking to the same physician, and she looked at the first prototype and said this is probably something we need to think about more. It was right before COVID. When things shut down, I talked to more OBGYNs and realized we needed to pivot and focus on remote patient monitoring because it was needed. COVID drove acceptance for digital health and remote monitoring. We actually acquired a digital health platform built for chronic disease management and revamped it for prenatal and postpartum care. The platform does remote patient monitoring for weight, blood pressure, and soon glucose when we launch our continuous glucose monitor. We also do mental health assessments during pregnancy and focus on moms that need help in the postpartum period to capture that much sooner. We're also looking at social determinants of health, which are huge drivers of maternal outcomes. Moms might not have access to transportation, food, or a safe place. It's an all-encompassing program for maternal health.

That's what we're focused on. We've seen moms in our engineering work where the baby had tachycardia, or a mom who had bradycardia and didn't know it. Without noticing, you can lose the baby.

It's probably around 80%. Clinical research after C-sections, regardless of outcomes, shows that about 80% of the time, the baby was not in distress. We're trying to fill in the blanks because we don't have a good picture of what's going on in there. This machine paints that picture. Right now, C-sections are often decided based on practice protocols using tachycardia, bradycardia, and fetal heart tones. After an hour of a bad tracing, another half hour, the baby is delivered because we don't know what's really going on. For example, after 41 weeks, there's a 1-5% higher risk of stillbirth, so mothers are often induced. With better information, we can avoid arbitrary decisions based on irrelevant data.

Exactly. In terms of how the mental health coaching works, if a mom decides to use the platform, she gets a scale and a blood pressure cuff. It's easy to use—she puts in batteries, the devices are configured for her, she stands on the scale, and the data goes to the clinician platform. There's also an app where she can see her weight trends over time, not just a point-in-time measurement. We do the same for blood pressure. With frequent blood pressure readings at home, we can titrate medications. Many moms end up in the ER with headaches and vision issues from hypertension, and they get admitted overnight. If caught earlier, it can be managed at home. For low-risk moms, there's a built-in protocol that can be customized by the physician. For high-risk moms, different protocols apply. We can also ship other devices. The mental health piece is something I'm personally passionate about. I had three pregnancies with no problems, but with my fourth, I gained a lot of weight and wasn't paying attention. I went to Coldstone many times for chocolate banana malts. At my six-week checkup, I started sobbing, and my physician helped me. I didn't have full postpartum depression, but it was real. One in five or seven women experience postpartum depression or anxiety. We do mental health surveys during pregnancy to establish a baseline and identify those at risk. We also assess social determinants of health throughout pregnancy, because a mom's life changes significantly after the baby is born.