Inside TCHMB: A Conversation with Collaborative Leadership

Our partners at the Michael & Susan Dell Center for Healthy Living and the UTHealth Houston School of Public Health hosted an engaging and insightful conversation with the leadership of TCHMB and dove into the heart of our collaborative efforts in perinatal healthcare. This panel highlighted key partnerships that are driving innovation and improving outcomes for mothers and babies across Texas.

Speakers:

Charleta Guillory, MD, MPH, FAAP

Patrick Ramsey, MD, MSPH

Manda Hall, MD

View slides here. 

Watch recording here.

Helpful Resources

• Texas Health Data - https://healthdata.dshs.texas.gov/

• Rural Texas Maternal Health Rescue Plan (position paper will be published on 10/25) - https://d2bozcc5ollgr4.cloudfront.net/programs/maternal-health/index.html

• TX RPC Project Health Policy Resource on Doula Services - https://sph.uth.edu/research/centers/dell/legislative-initiatives/tx-rpc-project-reports/Doula%20Services%20-%20Rapid%20Response%20Request_03232023.pdf

Family and Child Health Expertise Joins UTHealth Houston School of Public Health

Faculty, staff, and research initiatives, formerly from The UT System Population Health team, join UTHealth Houston School of Public Health in Austin to expand maternal and child health expertise. The Population Health team was established in 2015 to address the needs of maternal and child health through partnerships with and funding from state agencies. These partnerships led to the establishment of state-wide collaboratives and informing public health programs.

David Lakey, MD, vice chancellor for health affairs and chief medical officer for The University of Texas System entrusts UTHealth Houston School of Public Health to take on the collaborative. 

“For the past eight years, the Office of Health Affairs at UT System has been incubating the maternal and child health programs under Population Health. These maternal and child health programs have been successful and are now ready for full integration to UTHealth Houston School of Public Health in Austin,” said Lakey.

Population Health has produced over $6.4 million in research funding this past year, and over $30 million since its inception, for health improvement initiatives established and embedded throughout Texas. Funds are utilized to identify population health approaches to improve the health of Texas families, mothers, babies, and young children. 

“The vision of our location is ‘healthy children in a healthy world’.  For that to happen, we need to have healthy women. This initiative will enable us to improve the health of our littlest Texans by improving the health of their mothers and their support systems, including fathers and other family members.” said Hoelscher, who also serves as the director of the Michael & Susan Dell Center for Healthy Living. 

A key addition includes The Texas Collaborative for Healthy Mothers and Babies, a long-standing multidisciplinary network of health professionals throughout the state. Their mission is to advance healthcare quality, equity, and patient safety for all Texas mothers and babies. The collaborative hosts an annual summit in February to discuss and present topics related to that year’s theme. Most recently, the Summit’s 2023 theme was “Social Determinants of Health and How They Impact Maternal and Neonatal Health Outcomes”.

The new programs and initiatives oversee several projects to address and improve health with primary initiatives focused on the following: 

• Patient care quality improvement

• Expansion, implementation, and dissemination of clinical interventions

• Evaluation of prevention and early intervention methods

• Identification of disparities associated with infant mortality

• Information and support programs that promote community resilience and optimal childhood brain development

• Needs assessment for the early childhood system in Texas and evaluation of the impact of the state’s activities toward strengthening the early childhood system.

Three key researchers with expertise in maternal and child health join UTHealth Houston School of Public Health in Austin as newly appointed faculty, including Dorothy Mandell, PhD; Divya Patel, PhD; and Katharine Buek, PhD.  In addition to these new faculty members, the Austin regional location added 11 new staff members, with expertise ranging from neonatal nursing to project management to health equity.

The newest additions to the faculty body in Austin will continue to drive progress and transformation in their respective fields, particularly the below projects:

1. Texas Collaborative for Healthy Mothers and Babies (TCHMB), funded by Texas DSHS – PI: Deanna Hoelscher

2. CDC Perinatal Quality Collaboratives (Bringing a Health Equity Framework for the Texas Perinatal Quality Collaborative to Eliminate Disparities in Perinatal Health), funded by CDC – PI: Divya Patel

3. Texas Safe Babies, funded by the Department of Family & Protective Services (DFPS) – PI: Dorothy Mandell

4. Maternal Infant and Early Childhood Home Visiting Coordinated State Evaluation, funded by DFPS – PI: Dorothy Mandell

5. Healthy Families/Healthy Mujeres, funded by HHSC – PI: Divya Patel

6. Evaluation of the Preschool Development Grant Birth to Five, funded by the Texas Workforce Commission – PI: Dorothy Mandell

“We look forward to furthering the excellent work and collaborations that Dr. Lakey began and has nurtured over the past few years. We are grateful to Dr. Lakey, his staff, and the state agencies who have funded this work for their partnership and vision in achieving a healthier Texas for our children, our families, and our communities. ” said Hoelscher.

Q&A: Gillian Gonzaba, NNP-BC - Building Healthier Beginnings for the Tiniest Texans

There are critical gaps in the rates of breastfeeding and safe sleep practices among newborns in Texas. Breastfeeding is widely recognized as the most beneficial feeding method for infants, associated with reduced risks of infections, chronic conditions, and improved maternal health. Adherence to safe sleep practices is critical for reducing preventable sleep-related infant deaths, which disproportionately impact historically underserved populations in Texas. In 2019, sudden infant death syndrome (SIDS) was the fourth leading cause of infant mortality in the state, following congenital anomalies, prematurity, and complications of low birth weight.  Lactation and Safe Sleep Opportunities in Texas (LASSO-TX) is a new statewide quality improvement initiative (QI) focused on improving exclusive breastfeeding rates and the use of a mother’s own milk for Texas infants while promoting safe infant sleep best practices. LASSO-TX is modeled after the IHI Breakthrough Series Collaborative framework, which involves enrolled hospital collaborative learning and support as they work toward strengthening evidence-based care practices.

To support hospitals in their QI efforts, the Texas Collaborative for Healthy Mothers and Babies (TCHMB) will host three in-person learning sessions (February 2026, June 2026, and October 2026) with monthly action period calls in between. Hospitals will periodically submit de-identified aggregate-level data to track their progress and receive ongoing collaborative support, expert coaching, and technical assistance. As of August 2025, LASSO_TX hospital recruitment is underway.

Gillian Gonzaba, NNP-BC, a neonatal nurse practitioner and longtime partner in maternal-newborn quality improvement, sat down with me to highlight why the project matters.

1. What is LASSO-TX, and why is it important?

LASSO-TX is a unique opportunity for TCHMB to bring together maternal and newborn care teams across Texas. It’s [TCHMB’s] first opportunity to really partner across both maternal and neonatal care to improve the overall health of the mother-baby dyad. This effort is about making sure evidence-based standards show up in everyday practice. That takes more than just education and training; it requires a change in hospital culture and improving how systems work. Hospitals can lead the way by showing what good, evidence-based care looks like, partnering with families and building a supportive environment where all care teams work together.

We’re excited to begin this worthwhile pursuit of providing collaborative support to hospital improvement teams as they improve maternal and infant health outcomes across the state.

2. Why is this work particularly important in Texas?

Despite the well-established benefits breastfeeding provides for infants, not every baby born in the state of Texas is exclusively breastfed after birth. Texas also has several counties with the highest rates of sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID) in the United States. Hospitals are key to improving these outcomes by providing education and care that follows best practices.

Currently, the care families get can look different depending on the hospital. There are notable disparities in breastfeeding and safe infant sleep practices that persist across hospital settings and communities, especially among underserved populations. Our goal is to help support hospitals in removing systemwide processes and structural barriers to improve infant nutrition and care. We want families to get high-quality breastfeeding and safe infant sleep support, no matter the hospital.

3. What drew you personally to LASSO-TX?

Breastfeeding isn’t always natural or easy. Some moms and babies need extra support, and neonatal intensive care unit (NICU) nurses are called on every day to provide that help. When I first started as a NICU nurse, before becoming a nurse practitioner, I didn’t have any children of my own. That made it challenging to support moms who were learning to breastfeed. I called on my colleagues and friends who had nursed and watched lactation consultants with fascination.

We have some phenomenal lactation consultants across the state who are truly skilled at connecting with moms in ways that are unique to their craft. Later, once I became a mother myself, I was fortunate to achieve the breastfeeding goals I set for myself and my children, which deepened my understanding of how meaningful — and how hard — breastfeeding can be.

Many people think breastfeeding is a natural, automatic process: Just bring the baby close to the mom and they’ll know what to do. While that’s true for some babies, it isn’t for all. Some babies need extra help. Some moms need extra help. That’s where support makes a real difference.

Being part of LASSO-TX is an incredible opportunity to support hospitals in advancing care so they can better serve families and communities across the state. For me, it speaks to what about my work touches my heart: helping a mother form and nurture her unique bond with her baby. It’s unlike any other bond that exists because you’re giving your baby something created just for them exactly the right way every time.

I’m excited to support LASSO-TX and help expand breastfeeding and safe infant sleep supports across Texas.

4. How will you know if LASSO-TX is successful?

Success, to me, means hospitals have the resources to continue this work and build on their progress even after the initiative ends. The goal is for hospitals to develop the ability to effectively test, scale, and implement changes to achieve patient care objectives they set for themselves. We hope to lay a strong foundation by equipping hospital teams with the culture, education, and tools needed to keep moving forward.

It's not just about improving outcomes, though that’s important. We also want to give our partners quality improvement tools they can carry for LASSO-TX and any future projects. If we can do that, I believe we’ve succeeded.

Gillian Gonzaba, NNP-BC, is Co-Chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB) Neonatal Committee and a member of the TCHMB Executive Committee.

Women in Medicine Month

At the Texas Collaborative for Healthy Mothers and Babies (TCHMB), we are proud to use September (Women in Medicine Month) to recognize the outstanding women leaders driving our quality improvement (QI) efforts through their expertise, vision, and commitment to our Executive Committee and other workgroups and our internal staff. These women provide invaluable expertise and vision to drive our mission forward.

This Women in Medicine Month, we honor the women of TCHMB whose leadership and dedication are shaping perinatal QI efforts across our great state. Dr. Charleta Guillory, TCHMB chair, believes “The children of Texas need you — your voice, your passion, your vigor, your indomitable spirit.”

Their collective impact is reflected in the work of the remarkable women who serve on our Executive Committee and lead key initiatives across the state. As women medical leaders in Texas and nationwide, TCHMB women leaders in medicine advance health care quality and patient safety for all Texas mothers and babies.

Gloria Delgado, MSN, RNC-OB — Obstetrics Co-Chair, Executive Committee

Delgado serves as an Assistant Administrator of Women’s Services at University Medical Center of El Paso, overseeing labor and delivery, mother-baby care, and public health programs like Nurse Family Partnership. She brings extensive expertise in managing health care operations to ensure safe, high-quality care for mothers and babies.

Catherine Eppes, MD, MPH — Past Chair, Executive Committee

As Chief of Obstetrics at Ben Taub Hospital and a maternal-fetal medicine physician at Baylor College of Medicine, Eppes focuses on quality, safety, and infectious disease management in pregnancy. She has collaborated with the Centers of Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and Texas Medical Association (TMA) on initiatives including Zika virus prevention and perinatal care improvement.

Jasmine Farrish, CNM, MSN, MPH — At-Large Member, Executive Committee

Farrish, a Certified Nurse Midwife at Los Barrios Unidos Community Clinic, began her career as a postpartum doula and now oversees home visiting and midwifery programs. She is committed to providing personalized, nonjudgmental care to support families across the Dallas area.

Kendra Folh, DNP, RNC-OB, C-ONQS, CPHQ, LSSBB — Data Co-Chair, Executive Committee

Folh is Program Director for Women’s and Children’s Services at Memorial Hermann Healthcare System. Drawing from her personal experience as a preterm birth survivor, she drives QI initiatives and collaborates nationally on perinatal safety to champion healthcare innovation for maternal and neonatal populations.

Alice Gong, MD — Vice Chair/Chair-Elect, Executive Committee

Gong is a Professor of Pediatrics at UT Health San Antonio and Medical Director of the PREMIEre program and the Mother-Baby Unit at University Hospital. She has spent decades advocating for newborns and families, advancing early neurodevelopmental care, and educating generations of clinicians through her research, publications, and presentations.

Gillian Gonzaba, NNPC — Neonatal Committee Co-Chair, Executive Committee

A Neonatal Nurse Practitioner and Associate Director for High Reliability/Patient Safety and Simulation at Pediatrix Medical Group, Gonzaba leads multidisciplinary teams focused on QI, patient safety, and neonatal care. She has extensive experience with simulation training and process improvement in neonatal medicine.

Charleta Guillory, MD, MPH, FAAP — Chair, Executive Committee

Guillory, Professor of Pediatrics at Baylor College of Medicine and Director of the Neonatal-Perinatal Public Health Program at Texas Children’s Hospital, has led efforts to reduce Black infant mortality and improve newborn care. Her leadership in policy and community initiatives has had a profound impact on maternal and infant health statewide.

Sonal Zambare, MD — At-Large Member, Executive Committee member

Zambare, Assistant Professor of Obstetric Anesthesiology at Baylor College of Medicine, brings expertise in anesthesia, analgesia, and critical care for mothers during birth and postpartum. She is actively involved in patient safety, education, and simulation programs, and she supports care for mothers with substance use disorders.

TCHMB also recognizes the invaluable contributions of the non-voting women of the Executive Committee, including Drs. Manda Hall, Gayle Olson, Rashmi Rode, Emily Briggs, Ashley Lucke, and Angela Moemeka, Misty Wilder, MSW, and TCHMB staff members Susan Dimitrijevic, MSN, BSN, RNC-NIC, and Ebony Sherrill, BSN, RN, whose collective expertise supports TCHMB’s mission and helps advance maternal and infant health across Texas.

To learn about the TCHMB Executive Committee members and staff, follow us on social media, subscribe to our newsletter, and view tchmb.org.

Meet Dr. Alice Gong, TCHMB Vice Chair

Dr. Alice Gong is the current vice chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB). I spoke with Dr. Gong to learn more about her achievements and dedication to improving the health and well-being of newborns.

A Journey Rooted in Curiosity and Compassion

Dr. Gong's career began with a passion for medicine and a particular interest in pediatrics. She grew up in a small town in the Mississippi delta. After completing her undergraduate studies at Mississippi College, she began her journey in healthcare and entered medical school. Although she initially was drawn to pediatrics, it was during her clinical rotations that she was drawn to the complexities of neonatology. The delicate and critical transition that newborns make after birth fascinated her, leading her to pursue a residency in pediatrics and a subsequent fellowship in neonatology.

Significant Research in Neonatal Care Dr. Gong’s training and research has taken place across the United States. Her early research work in neonatology focused on neonatal respiratory distress syndrome, which at the time was the leading cause of death of infant mortality. She was part of some of the initial research on surfactant replacement therapy1, which became a cornerstone of neonatal care and was instrumental in improving mortality and morbidity for premature newborns.

Additional research areas included lung physiology, retinopathy of prematurity in partnership with retinal ophthalmologists, and breastfeeding quality improvement, the latter of which aligns with Breastfeeding Learning Collaborative with Safe Infant Sleep Modeling, a current TCHMB initiative.

A Vision for the Future

Looking ahead, Dr. Gong’s commitment to improving neonatal and maternal healthcare remains strong. As vice chair, she hopes to ensure the progress made in urban hospitals is extended to small community hospitals, particularly those in rural areas. For Dr. Gong, the goal is to elevate care standards in high-level NICUs across the state, regardless of proximity to urban area hospitals.

In her words: "A woman that lives in rural Texas, her wants and desires for her child and her family are no different than someone who lives in an urban area."

A Legacy of Dedication

Dr. Alice K. Gong’s career is a testament to a lifetime of dedication to improving the health of newborns and supporting families in their most vulnerable moments. Through groundbreaking research, system-wide improvements, and a compassionate approach to neonatal care, Dr. Gong has changed the trajectory of countless lives. Her work continues to inspire future generations of healthcare professionals and advocates for maternal and neonatal health.

Her personal mission mirrors that of TCHMB, which works to advance healthcare quality and safety for all Texas mothers and babies and finds success in its collaboration-based efforts. Both Dr. Gong and TCHMB work to ensure better care standards can flourish across the state.

As she reflects on her career, Dr. Gong's mission remains clear: to create a world where every baby can grow up healthy, safe, and nurtured by their families and communities. Her legacy is one of scientific achievement and a profound expression of her compassion and commitment to improving the world for the most vulnerable.

Hear Dr. Carey Eppes and CheyAnne Harris on AIM for Safer Birth!

Dr. Carey Eppes and CheyAnne Harris spoke with Aim for a Safer Birth about implementation for the Maternal Early Warning Signs (MEWS) in maternal health care. In this episode, Eppes, the immediate past chair for TCHMB, and Harris, the Director of Clinical Excellence and Operations for Titus Regional Medical Center, addressed how MEWS implementation can serve as a resource for every facility.

Results from NAT Initiative show promising, meaningful clinical improvements in newborn healthcare

The NAT Initiative Executive Summary delivers background and overview information, results, key findings, and lessons learned from the Newborn Admission Temperature initiative.

The Newborn Admission Temperature (NAT) Initiative was the first TCHMB project to measure outcomes disaggregated by race and ethnicity from hospitals, an important step toward understanding and reducing disparities in perinatal healthcare and health outcomes in Texas. Of particular note are the following findings:

• The findings of decreased hypothermia among NICU admissions — in NICUs that consistently reported race and ethnicity disaggregated data — highlight the potential of statewide initiatives for improvement in settings caring for the most vulnerable newborns.

• The NAT Initiative identified significant disparities in hypothermia incidence, with newborns of non-Hispanic Black mothers having approximately twice the incidence compared to newborns of non-Hispanic White mothers.

More key findings, data, and conclusions & future directions are available in the NAT Initiative Executive Summary.

Q&A: Dr. Charleta Guillory, TCHMB Chair

Dr. Charleta Guillory is the current chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB). I sat down with Dr. Guillory to learn more about her achievements, passion for infant and mother health, and her vision for TCHMB during her tenure as chair. 

Dr. Guillory was selected as chair after serving as co-chair of the neonatal committee for 6 years. She is a Professor of Pediatrics in the Section of Neonatology at Baylor College of Medicine and Director of the Texas Children's Hospital Neonatal-Perinatal Public Health Program.

1. Please describe your education, specifically your medical education.

I was one of the first 2 Black female graduates (out of a mere 4 total women in the entire program) who completed my medical education at Louisiana State University Medical School in New Orleans, earning my MD degree in 1974. Following this, I completed a Pediatric Residency at the University of Colorado Medical Center and Louisiana State University from 1975 to 1978. I then pursued a Neonatal-Perinatal Medicine Fellowship at Baylor College of Medicine's Department of Pediatrics in Houston from 1978 to 1981, and I am board certified in both pediatrics and neonatal-perinatal medicine.

My education also includes leadership and national policy training through the Gallup Leadership Institute and the American Political Science Association's Congressional Fellowship Program. I was 1 of 6 physicians in the United States to receive the Robert Wood Johnson Health Policy Fellowship from the National Academy of Science and Institute of medicine, where I served as a legislative assistant in the United States Senate (office of Senator John B. Breaux, LA) promoting both health policy legislation and programs.

Additionally, I earned a Master of Public Health from UTHealth Houston School of Public Health in 2015, completing a thesis on the High Rate of Prematurity in African-American Women in Houston, Texas and focusing on efforts to advance programs and policies that improve neonatal health outcomes.

2. Please describe your career experience within medicine.

My very first job after completing my fellowship in 1981 was co-director of the Woman's Hospital of Texas NICU, transitioning the nursery from Level II to Level III. In addition, I directed the Texas Children's Hospital Level II Nursery for 21 years, where I established admission and discharge guidelines and coordinated quality improvement projects. My leadership experience included working with multidisciplinary teams of neonatologists, nurse practitioners, fellows, residents, medical students, and nursing staff.

Throughout my career in medicine, I have held numerous key roles that have significantly impacted maternal and child health. As the Director of the Neonatal-Perinatal Public Health Program and the immediate past Director of the Texas Children's Hospital Level II Nursery.  I have managed the care of infants with complications such as prematurity, birth defects, and metabolic disorders, overseeing transfers from across Texas and beyond.

Additionally, my training through the Robert Wood Johnson Health Policy Fellowship, Congressional Fellowship, and Gallup Institute Leadership Course has equipped me to influence healthcare policy. As Chair of the March of Dimes State Prematurity Campaign and the State Advocacy and Government Affairs committee, I have led statewide initiatives to reduce premature births and developed materials for legislative advocacy. I also currently direct the Patient Advocacy Elective in Pediatrics at Baylor College of Medicine, further contributing to my extensive career in educating others in neonatal healthcare.

I also chaired the Texas Department of State Health Services (DSHS) Newborn Screening Advisory Committee — championing the increase of the number of newborn screens being done by the state to help decrease infant mortality — and served 10 years on the Texas Health and Human Services (HHS) Perinatal Advisory Council (PAC) — designating levels of neonatal and maternal care.

Recently, I was appointed to serve on the Food and Drug Administration (FDA) Pediatric Advisory Committee and was appointed to the American Academy of Pediatrics (AAP) National Committee on Fetus and Newborn. I served as President of the Texas Pediatric Society (TPS) of the American Academy of Pediatrics for 2021 and now serve as the TPS/AAP Chapter Chair President. My commitment to improving the health of infants led to the Secretary of Health and Human Services appointing me to serve on the HRSA Advisory Committee on Infant and Maternal Mortality.

Still today, I continue to work in the Neonatal Intensive Care Unit Level IV and serve on the ECMO team. My advocacy for improving maternal and infant health, especially for vulnerable populations, has been a central theme in my work. I have been dedicated to reducing infant mortality and eliminating disparities in health outcomes based on socioeconomic, racial, and ethnic factors.

3. How did you become involved with TCHMB?

I started as a member of the Expert Panel in 2011 advising Healthy Texas Babies, the state infant mortality reduction initiative housed at DSHS, and I continued as a member of TCHMB at its inception, which began officially operating as the state perinatal quality collaborative in 2013. As the group continued to evolve, I served as the Co-Chair of the Neonatal Standing Committee of the Executive Committee for over 6 years.

4. What does it mean to you to be TCHMB Chair?

Every job that I have, or have had, I approach with commitment, service, and an opportunity to improve the lives of others. I bring to TCHMB a vast variety of experiences/preparation to work in a community of like-minded experts to effect positive change. I feel both humbled and proud to have the privilege to be part of this awesome team.

I remain committed to identifying the social determinants of health and their effects on the maternal and infant population before and after NICU admission. As a leader in the field of neonatology at the city, state, and national levels, my mission is to identify and implement solutions for these adverse determining factors that impact infant and maternal health.

In my tenure as TCHMB Chair, I aim to achieve several key goals that align with best practices in maternal and child health. Firstly, I intend to reduce infant mortality rates and improve overall infant and child health outcomes, particularly focusing on addressing health disparities. By enhancing access to high-quality care for vulnerable populations, I hope to create more equitable health outcomes for all Texas families.

Secondly, I plan to implement and support quality improvement initiatives across neonatal and perinatal care units. This includes developing and refining guidelines and protocols to ensure consistent, evidence-based care for premature and critically ill infants. Collaborating with healthcare professionals, I will promote best practices and foster a culture of continuous improvement.

Lastly, I hope to build collaboration and knowledge sharing among healthcare providers, researchers, and policymakers. By creating a robust network of partners, we can drive innovation and ensure that Texas remains a leader in neonatal and perinatal care.

Through these efforts, I aspire to make a lasting impact on the health and well-being of mothers and infants, contributing to a healthier future for Texas families and continuing to make the work of TCHMB impactful.

Written by Kirsten Handler, Communication Specialist at UTHealth Houston School of Public Health in Austin. 

TCHMB is funded by the Texas Department of State Health Services.

Understanding Preeclampsia: A Guide for Preeclampsia Awareness Month

May is Preeclampsia Awareness Month, an annual event that promotes improved healthcare practices as they relate to preeclampsia. Patients are encouraged to share their experiences, and researchers, clinicians, and legislators are encouraged to prioritize preeclampsia research. The Preeclampsia Foundation, which leads a month-long campaign about the hypertensive disorder every May, named the 2024 theme ‘Predict Prevent Prevail.’ 

Texas Collaborative for Healthy Mothers and Babies (TCHMB) — the state’s perinatal quality collaborative that comprises healthcare providers, scientists, hospitals, state agencies, advocates, and insurers — developed Understanding Preeclampsia: A Guide for Preeclampsia Awareness Month to support improved care and outcomes for preeclampsia patients in Texas.  

Defining Preeclampsia 

Preeclampsia is a life-threatening condition that affects 5-8% of pregnant patients, characterized by elevated blood pressure (BP) and, at times, elevated protein in the urine (proteinuria). It may be accompanied by other symptoms, including chest pain, abdominal pain, liver problems, headaches, and changes in vision.  

Alone, each of these symptoms does not indicate preeclampsia, but it’s important for pregnant patients to report these symptoms and any existing conditions to their healthcare provider. Some conditions put pregnant patients at a higher risk of developing preeclampsia: 

• A woman who has never delivered a baby 

• Type 1 or Type 2 diabetes 

• History of hypertension 

• 35 years or older 

• Teenager (under 20) 

• Chronic medical conditions, including kidney disease or Lupus 

• Preeclampsia/hypertension in a previous pregnancy 

• Twin pregnancy 

Diagnosing Preeclampsia

Providers will diagnose preeclampsia when a patient meets the following conditions: 

• Been pregnant for at least 20 weeks 

• Reported systolic BP of 140 or higher -or- diastolic BP of 90 or greater 

• On at least 2 occasions that are at least 4 hours apart

A diagnosis of preeclampsia can be given with or without the presence of proteinuria. 

Treating Preeclampsia 

The course of action following a preeclampsia diagnosis depends on the stage of pregnancy. In most cases, a patient confirmed to have BP greater than 140/90 will be sent for an initial evaluation at a hospital, where providers will monitor BP, collect laboratory tests including a urine test for proteinuria, and assess for symptoms of preeclampsia.

Treatment for Preeclampsia Based on Stage of Pregnancy

To prevent preeclampsia in patients at risk, doctors will prescribe a low-dose aspirin at around 16 weeks of gestation.

Developing Recognition and Response to Postpartum Preeclampsia in the Emergency Department (PPED), a TCHMB Quality Improvement (QI) Project 

11% of pregnancy-related deaths are related to preeclampsia/eclampsia, with 50% of those deaths occurring in the first six weeks (42 days) after delivery, according to the Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report 2022. Consequently, it is important for the public to recognize preeclampsia symptoms, which can occur not only during pregnancy but also during the postpartum period. 

Based on this data — and because so many patients who experience preeclampsia symptoms visit the emergency room — TCHMB developed the PPED QI project. This initiative aims to reduce maternal morbidity and mortality related to severe hypertension in postpartum patients by increasing the collaboration between obstetric and emergency departments with: 

• Enhanced screening for postpartum status 

• Education on diagnosis, treatment, and follow-up care in the emergency department 

Latest Research and Future Directions 

Research into preeclampsia has recently focused on understanding its underlying causes, with particular attention to the placenta’s role. While the exact cause remains elusive, ongoing studies are investigating inflammatory components and antibodies that may contribute to the condition. Experts predict that within the next decade, advancements in this area will provide valuable insights into prediction and prevention strategies. 

Clinical Review 

Special thanks to the following healthcare professionals for contributing their expertise to this article: 

• James Hill, MD, the Obstetrics Committee Co-Chair for TCHMB and the Division Chief for the Division of Maternal-Fetal Medicine at Baylor College of Medicine/The Children’s Hospital of San Antonio. Previously, he was a Field Artillery officer and retired Colonel in the United States Army and a mathematics professor at West Point. 

• Susan Dimitrijevic, BSN, RNC-NIC, the Senior Nurse Program Manager for TCHMB. For the past 25 years, she has focused her nursing career on Neonatal Intensive Care, caring for critically ill infants and their families. Before joining TCHMB, she was the Neonatal Program Manager and Clinical Nurse Manager of the Level NICU Transport team at Dell Children’s Medical Center. 

Written by Kirsten Handler, Communication Specialist at UTHealth Houston School of Public Health in Austin. 

Learn about postpartum preeclampsia in the emergency department

Recognition and Response to Preeclampsia in the Emergency Department

Speaker:

Catherine Eppes, MD, MPH
Maternal Fetal Medicine Physician Baylor College of Medicine Division
Director, Maternal Fetal Medicine Chair, TCHMB
Executive Committee Faculty Medical Director, TexasAIM initiative

Useful links:

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