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Voices From the Field: Combating Maternal Mortality Through Statistics and Epidemiology

By Lee Cannon

Jasmine Mack, M.P.H., M.S.
Jasmine Mack, M.P.H., M.S., is an NIH Oxford-Cambridge Scholar currently completing a research fellowship at the University of Cambridge in Cambridge, England, working toward a Ph.D. jointly supported by the university and NIEHS. (Photo courtesy of Jasmine Mack)

Jasmine Mack, M.P.H., M.S., a Ph.D. candidate at the University of Cambridge in Cambridge, England, and NIEHS research fellow, is determined to move the needle on maternal mortality. She is combining statistics, genetics, and epidemiology to hunt for causes of hypertension, or high blood pressure, during pregnancy. Hypertension during pregnancy increases the risk of serious health issues, like preeclampsia and preterm delivery, and potentially death, for both the birthing person and baby.

Mack is particularly focused on the maternal health crisis she sees among Black, Latinx, and Indigenous pregnant people in the U.S., who die from pregnancy complications more frequently than counterparts of European descent.

Growing up, Mack wanted to become a pediatrician. However, her introduction to the public health field during her undergraduate degree at Emory University changed her direction. She went on to earn a Master's of Public Health degree with a focus on maternal and child health from Boston University and a Master's of Science in biostatistics at the University of Michigan.

Mack is part of the NIH Oxford-Cambridge Scholars Program , an accelerated doctoral program in biomedical research that partners doctoral students with researchers both at NIH and in the U.K. Mack splits her time between Cambridge and Durham, North Carolina. At Cambridge, she works with mentor Gordon Smith, DSc., head of the Department of Obstetrics and Gynaecology. At NIEHS, she collaborates with Biostatistics and Computational Biology Branch researchers, under the mentorship of branch chief Alison Motsinger-Reif, Ph.D.

Improving Health with Data

Jasmine Mack, M.P.H., M.S.
Mack conducts statistical analyses to uncover causes behind pregnancy complications and discover ways to detect and possibly prevent adverse outcomes. (Photo courtesy of Jasmine Mack)

In her research, Mack uses U.S.- and U.K.-based datasets to search for statistical trends in hypertensive disorders and pregnancy outcomes.

"I want to know how the environment and genetics play a role in the development of obstetric diseases like hypertensive disorders, Mack said. "I'm trying to look holistically at the problem and to leverage existing data to inform future interventions."

She is analyzing data about the proteins that circulate between the pregnant person and fetus through the placenta, looking for clues on how to predict potential complications. She hopes to identify genetic markers that healthcare providers could detect through tests, providing early warning that a healthy-looking pregnancy could present complications later. Such genetic tests, Mack asserts, could save countless lives, especially in parts of the U.S. and the world where obstetrics care, or care during pregnancy and childbirth, is harder to access.

"There are a lot of places in the United States, called obstetrics deserts, where people have to travel far to get care. There have been cases when birthing people need emergency obstetric care, but they don't make it in time, and unfortunately, the pregnant person passes away."

Obstetrics deserts are not a coincidence, as Mack points out. The field is and has always been underfunded and under-researched, compared to fields that examine health issues affecting men.

"We are about 100 years behind where we should be in what we know about pregnancy and the female reproductive system," Mack stated. "There are a lot of topics that are understudied, specifically around adverse pregnancy outcomes."

International Data Lends Broader Perspective

Jasmine Mack, M.P.H., M.S.
In her free time, Mack competes with the University of Cambridge powerlifting team. On April 5, she won her second silver medal in the sport at the British Powerlifting organization’s 2023 British University Championships held at Moulton College in Northampton, England. (Photo courtesy of Ben Austrin, University of Cambridge powerlifting coach)

According to Mack, a benefit of the dual Ph.D. program is the amount and quality of data she can access. Leveraging both NIH and University of Cambridge resources has given Mack access to data from four large cohort studies, including the Personalized Environment and Genes Study (PEGS) cohort and the National Institutes of Health All of Us Cohort in the U.S., and the UK Biobank plus the Pregnancy Outcome Prediction Study (POPS) cohort in the U.K. She hopes to use this combined data to reveal causes of adverse outcomes, investigate inequities, and save lives.

Another benefit of her program's international angle is that Mack's work encompasses different disciplines. Her work with her NIH mentor, Motsinger-Reif, in biostatistics and statistical genetics meshes with her clinical obstetrics and gynecology work under Smith at Cambridge, allowing Mack a broader view of the pregnancy-outcomes issue. Additionally, Mack can study the differences between the U.S. and U.K. health care systems and populations. For example, while the U.K. offers universal health care, disparities in health outcomes still exist for ethnic minorities, like people of African and South Asian descent. Mack believes comparing the two health care systems can illuminate reasons behind the disparities.

A Future in Addressing Health Disparities

Mack aspires to create a worldwide consortium of data that can show how genetics and the environment influences various stages of pregnancy. She is especially interested in including data from nations with health-outcome disparities among people of different races and ethnicities, such as the U.S., U.K., Canada, and Brazil - where data show Afro-Brazilians are disproportionately affected by more adverse pregnancy outcomes of all the nation's ethnic groups.

Mack plans to become a practicing physician, while continuing her research. She also hopes to certify as a doula, a trained helper who provides information, emotional support, and physical comfort to a mother before, during, and right after childbirth. Mack believes doula training will expand her toolkit as a physician-scientist, as well as enable her to partner effectively with midwives and other doulas in her future practice.

"I'm grateful to be in a position, hopefully, to make a difference in how pregnancy is carried out in the future, especially for people historically excluded from research," Mack said. "I hope the work I'm doing is going to positively contribute to the body of research and the ways we address racial and ethnic disparities."