Saving Maternal Lives — With a Magic Marker

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Pregnant African Woman

Giving birth is never entirely safe or even remotely easy — especially in the developing world, where prenatal care may be nonexistent, postnatal care little better and access to hospitals or midwives is unreliable. That’s why roughly 350,000 women die in childbirth each year — 99.5% of them in the developing world. One of the greatest causes of maternal mortality — 12% of the total — is pre-eclampsia or eclampsia (PE/E), dangerously high blood pressure that occurs during pregnancy and often goes entirely undetected. Now, a group affiliated with Johns Hopkins University in Baltimore is working to solve that problem.

The most straightforward way to test for PE/E is, of course, to take a pregnant woman’s blood pressure. But a lot of women experience hypertension during pregnancy. Pre-eclampsia and eclampsia are more severe and more dangerous, possibly leading to heart or kidney damage, seizures and more. One sign that ordinary gestational hypertension is at risk of developing into PE/E is proteinuria — or excessive proteins in the urine. This too is easy enough to test for — but “easy” depends on location and in the developing world, the lab resources and trained technicians often aren’t available. (More on Uterus May Be More Important than Egg Quality for Healthy Babies)

Now the Johns Hopkins Program for International Education in Gynecology and Obstetrics  (JHPIEGO) along with the University’s Center for Bioengineering Innovation & Design is taking an extremely low-tech approach to solve a very serious problem. The group is testing the development of a Magic Marker-type pen that can be loaded not with ink, but with a reagent that reacts to the presence of  hypertension-related proteins. Apply that to a strip of the right kind of paper and dip it in urine, and it will turn a telltale blue if too much protein is present.

Markers are extraordinarily well-suited to a job like this. They can be kept airtight, they go through their supply of whatever liquid they’re loaded with very sparingly, and they are easy to toss in a pocket and carry out into the field. As for the paper that would be used to make the dip strips? Coffee filters cut to the proper size turn out to do the job splendidly.

A preliminary study JHPIEGO conducted in Nepal has proven the effectiveness and reliability of the marker, but a lot of R&D lies ahead. Coffee filter paper is not the sturdiest stuff, and any leakage of the reagent could saturate the strip. The amount of chemical the pen releases with each stroke thus has to be carefully controlled — something that could also help extend the life of any one marker. And while it is not necessary to keep the device refrigerated — maintaining the so-called cold-chain from manufacturer to clinic to patient — there’s no telling  what the heat and humidity of many developing nations will do the device over time. Local populations would also have to be trained  to use the marker and read the results. (More on 5 Pregnancy Taboos Explained (or Debunked))

Finally, as in so much else in the field of global health, cost is everything. JHPIEGO estimates that a starting price of as low as one penny per pen would be be the best way to make widespread adoption possible, especially since obstacles in development or delivery could drive that cost up.

For all those reasons, it’s not yet clear when the pen will actually be rolled out, though wider upcoming field trials in Nepal sometime this spring should help answer the question. With pre-eclampsia and eclampsia claiming the lives of tens of thousands of mothers — not to mention their babies — every year, no one at Hopkins is inclined to waste time.

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