Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: Exploring Encompass RNA PreE (At-Home) Test
Date: April 4, 2026
Host: Dr. Chapa

Overview

This episode focuses on the new Encompass RNA PreE at-home test by Mervey, designed to predict preeclampsia risk between 18 and 22 weeks of pregnancy. Dr. Chapa breaks down the science behind the test, its real-life clinical application, and the limitations of predictive testing—especially in light of existing management protocols (like aspirin prophylaxis). The episode is aimed at keeping clinicians informed so they aren’t caught off guard when patients bring in DTC (direct-to-consumer) test results.

Key Discussion Points & Insights

1. Innovation in Predictive Testing and Clinical Actionability

• Not all new tests change management or improve outcomes.
  • “Sometimes we get tests that we get a result for and we're like, okay, I dig it. I'm with it. Now what...we're not really sure of what to do with the result because we don't have any targeted treatments for it.” (03:05)
• Previous example: Thermo Fisher test (serum biomarker screening for inpatients already diagnosed with preeclampsia).
• Both ACOG and SMFM said: "Insufficient data to recommend management strategies after a positive or a negative test result." (04:32)

2. Introduction to the Mervey Encompass RNA PreE (At-Home) Test

• New DTC and office-offered blood test predicts preterm preeclampsia risk (9 in 10 positive results correlated with preterm preeclampsia).
• Drawn between 18–22 weeks, sent to a central reference lab, and results are delivered to an app in 10–14 days.
• “Patients can order this. They'll send off a phlebotomist to their house between 18 and 22 weeks, draw a blood test. It goes to a CLIA certified lab. Boom, boom, boom, they get a little app, and it says, hey, you have 99% chance of not developing preeclampsia or, oh, you have a higher risk of developing preeclampsia.” (05:48)

3. Management Implications: What Do We Do with a Positive Test?

• Aspirin: The only proven preventive therapy; ideally started at or before 16 weeks for greatest effect.
  • “The peak time to start Aspirin is...at or under 16 [weeks].” (08:21)
  • “Starting aspirin at 22 weeks is fine, but you get most of the benefit...at or under 16 weeks.” (08:32)
• If patient presents at 22 weeks with a positive test, “Honey, you missed that boat.” (12:02)
• Lifestyle modifications and enhanced surveillance are suggested, but no data yet that these change neonatal outcomes if started later.

4. Three Approaches to Preeclampsia Prevention

• ACOG-endorsed risk-factor stratification: Assigns low, moderate, or high risk and gives aspirin where indicated.
• Universal aspirin: Dr. Chapa’s preference—give everyone aspirin unless contraindicated, adjusting dosage for very high risk.
• Biomarker-based (like Encompass): New, but clinical impact versus earlier preventive measures is unclear.
  • “I'm all for innovation...But is this going to take off and revolutionize preeclampsia management? No way.” (22:39)

5. Science & Validation of the Test

• Uses cell-free RNA (cfRNA) signatures and AI algorithms.
• Supported by a publication in Nature Communications (2025), validating the correlation between certain RNA profiles at 18–22 weeks and preeclampsia risk.
  • “There is some science there. This makes biological sense, guys. The science behind Mervy Encompass is legit. It does work.” (09:03)
• Has a reported 99% negative predictive value.

6. Eligibility and Limitations

• Only validated for:
  • Singleton pregnancies.
  • Maternal age ≥ 35 at delivery and WITHOUT:
    • Multiple gestation
    • Prior preeclampsia
    • Chronic hypertension
    • Renal disease
    • Lupus/antiphospholipid syndrome
    • Type 1 or 2 diabetes
• “It's a very niche deal, right? Again, I'm not trying to poopoo this...I don't know what to do with this.” (17:22)
• Excludes many high-risk groups that would otherwise benefit most.

7. Direct-to-Consumer Complications

• Patients may present with app-based results and little context.
• May increase patient anxiety without changing management.
  • “I think the use of cell free RNA as a direct to consumer or physician offered test. You gotta know what you're getting and the limitations here.” (18:20)
• “I'm not feeling it right now. And I don't like them going direct to consumer because it's going to put physicians in a bind.” (23:08)
• Dr. Chapa’s advice: Don’t be blindsided when patients ask about it.

Notable Quotes & Memorable Moments

• "Well, isn't that special?" (multiple times; first at 07:50)—Dr. Chapa’s tongue-in-cheek refrain highlighting the skepticism about real-world utility.
• “If your patient comes into you with their app and it says, I am at high risk, and they're 22 weeks already, your answer is, honey, you missed that boat. That should have been 16 weeks or under to start aspirin, but I guess we'll do it now.” (12:00)
• “I think aspirin should be in prenatal vitamins. As long as you don't have...some kind of gastritis or bleeding ulcer or aspirin induced airway...aspirin is legit. It works. I think everybody should get it.” (12:40)
• “Clinical actionability—yes, that is actually a word—the actionability of a study is kind of uncertain.” (21:29)
• “We definitely need real world, multi site population based studies that these things work. And right now ACOG says these biomarkers for preeclampsia hypertensive disorders. I don't know what to do with this. Give them aspirin.” (21:03)
• “Podcast family, I think I have done what I'm supposed to do. I think we have worn out the church lady from SNL: Isn’t that special?” (25:41)

Timestamps for Key Segments

• 03:00: Problems with prior predictive biomarker tests
• 05:48: Introduction of the Encompass test and DTC model
• 08:21: Ideal aspirin initiation window vs. test timing
• 10:00: Outline of current prevention strategies
• 11:14: Direct-to-consumer concerns and physician preparedness
• 13:30: Test science: RNA signatures and algorithms
• 16:09: Limitations and eligible patient populations
• 18:20: Clinical utility and potential for increased anxiety
• 21:03: Need for better studies and ACOG’s current stance
• 22:39: Overall clinical impact assessment
• 25:41: Final wrap-up and advice

Summary

Dr. Chapa critically analyzes the new Encompass RNA PreE at-home test for preeclampsia prediction, recognizing the test’s scientific validity but highlighting significant limitations in its clinical utility—especially due to timing, restricted eligibility, and lack of actionable interventions beyond aspirin (which is most effective if started prior to the window when this test is performed). Dr. Chapa’s consistent refrain is to stress that clinicians should be aware of the test, its direct-to-consumer marketing, and should continue to trust established protocols (especially aspirin prophylaxis per risk factors or universally, as he personally endorses) until more robust real-world data and management pathways emerge. The episode’s light, practical tone helps clinicians prepare for patient questions and avoid being “blindsided” by new technology.