Maternal and Perinatal Health Research collaboration, India (MaatHRI): improving outcomes in pregnant women with iron deficiency anaemia

印度孕产妇和围产期健康研究合作 (MaatHRI)：改善缺铁性贫血孕妇的结局

• 批准号: MR/P022030/1
• 负责人: Manisha Nair
• 金额: $ 138.29万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP022030%2F1
• 关键词: Maternal; Perinatal; Health; Research; collaboration

Globally 210 million women become pregnant each year and more than 300,000 women die from preventable complications. India has the highest number of maternal deaths of any country. Every year, about 45,000 pregnant women die in India compared to only 70 in the UK, with some states like Assam being worse. Although Assam has only half the population of UK, 6 pregnant women die every day. In addition to death, around 5 million pregnant women in India suffer a life-threatening complication. It is therefore essential that work is done to investigate these complications to improve maternal health. A starting point for this is to ensure that maternal deaths and severe complications are identified accurately so they can be researched. I have already tested the feasibility of such work in two teaching hospitals in Assam, where I successfully collected information on over 22,000 women. I will extend this method (Objective 1) to 16 hospitals in Assam and 2 in Maharashtra, which would enable information to be collected on 100,000 deliveries a year. This approach, using a 'research platform' called 'Maternal and Perinatal Health Research collaboration, India (MaatHRI)', will provide a model for examining maternal health in other states in the future. Anaemia is an important cause of maternal death in India. From my initial work, I found that, over one year, half of the deaths of mothers were due to anaemic heart failure and a third were due to severe bleeding at childbirth with some of the excess risk being related to the management of labour and delivery in anaemic women. Surprisingly, very little is published on maternal anaemic heart failure, so we do not know what individual factors are contributing to it, or why some women die from it whilst others do not. Similarly, we need more information on the safety of inducing and stimulating delivery in anaemic women. As these two areas are the most important, I will start by using MaatHRI to investigate them.I will (1) compare two groups of pregnant women with moderate and severe anaemia: one group who develop heart failure and another who do not, to look at the clinical features and factors leading to heart failure; (2) I will facilitate expert reviews of a sample of pregnancy care notes of women who suffered from heart failure to identify factors that led to the death of some women and the positive elements that saved the lives of others (Objective 2). I will also examine the safety of inducing and stimulating the process of labour in anaemic women (Objective 3) by comparing the outcomes of induction/ stimulated birth with that of normal vaginal delivery, and examine factors that may be influencing the outcomes. The results will be used to develop guidance for (1) the prevention and management of anaemic heart failure, and (2) the safety of inducing or stimulating birth in pregnant women with anaemia. I will do this by running three workshops in years 4-5. This will be done alongside plans to disseminate results and to encourage scaling up of MaatHRI to other hospitals and states (Objective 4). Finally, I will develop proposals for research to follow on from this fellowship, using MaatHRI (Objective 5). The role of infectious diseases as risk factors for the health and well-being of mothers and babies will be explored. To this end, a survey of infectious diseases in pregnant women will be initiated in year-4. In addition, I will design studies in other areas identified as problematic in my early work, namely: eclampsia, septicaemia and ruptured womb.To summarise, this work will (1) set up a much needed research 'platform' to survey key maternal health problems in India; thus enabling (2) studies to understand the reasons for serious complications (starting with anaemic heart failure and safety of induction in anaemic women); leading to (3) the development of guidance and interventions which can be tested and implemented in the future to save the lives of mothers and babies.

全球每年有2.1亿妇女怀孕，30多万妇女死于可预防的并发症。印度是孕产妇死亡人数最多的国家。印度每年约有4.5万名孕妇死亡，而英国只有70名，阿萨姆邦等一些邦的情况更糟。虽然阿萨姆邦的人口只有英国的一半，但每天有6名孕妇死亡。除了死亡之外，印度约有500万孕妇患有危及生命的并发症。因此，必须开展工作，调查这些并发症，以改善产妇保健。这方面的出发点是确保准确查明产妇死亡和严重并发症，以便对其进行研究。我已经在阿萨姆邦的两家教学医院测试了这种工作的可行性，在那里我成功地收集了22 000多名妇女的信息。我将把这种方法（目标1）推广到阿萨姆邦的16家医院和马哈拉施特拉邦的2家医院，这将能够收集每年10万次分娩的信息。这种方法利用一个名为“印度孕产妇和围产期健康研究合作”（MaatHRI）的“研究平台”，将为今后检查其他邦的孕产妇健康提供一个模型。贫血是印度产妇死亡的一个重要原因。从我最初的工作中，我发现，在一年多的时间里，一半的母亲死亡是由于贫血性心力衰竭，三分之一是由于分娩时严重出血，其中一些额外的风险与贫血妇女的分娩管理有关。令人惊讶的是，关于母亲贫血性心力衰竭的文章很少，所以我们不知道是什么因素导致了它，也不知道为什么有些妇女死于它，而另一些却没有。同样，我们需要更多关于贫血妇女诱导和刺激分娩安全性的信息。因为这两个领域是最重要的，所以我将从使用MaatHRI来研究它们开始。我将(1)比较两组中度和重度贫血的孕妇：一组发生心力衰竭，另一组没有发生心力衰竭，看看导致心力衰竭的临床特征和因素；(2)我将促进专家对患有心力衰竭妇女的孕期护理记录样本进行审查，以确定导致一些妇女死亡的因素和挽救其他妇女生命的积极因素（目标2）。我还将通过比较引产/刺激分娩与正常阴道分娩的结果，检查贫血妇女引产和刺激分娩过程的安全性（目标3），并检查可能影响结果的因素。研究结果将用于以下方面的指导：(1)贫血性心力衰竭的预防和管理；(2)贫血孕妇诱导或刺激分娩的安全性。为此，我将在第4-5年举办三次研讨会。与此同时，还将计划传播结果，并鼓励将maathi扩大到其他医院和州（目标4）。最后，我将使用MaatHRI（目标5）开发研究建议，以遵循该奖学金。将探讨传染病作为母亲和婴儿健康和福祉的危险因素的作用。为此目的，将在第4年开始对孕妇传染病进行调查。此外，我还将设计其他在我早期工作中发现有问题的领域的研究，即：子痫、败血症和子宫破裂。总而言之，这项工作将(1)建立一个急需的研究“平台”，以调查印度的主要孕产妇健康问题；从而使(2)研究能够了解严重并发症的原因（从贫血性心力衰竭和贫血妇女诱导的安全性开始）；导致(3)制定指导和干预措施，这些指导和干预措施可以在未来进行测试和实施，以挽救母亲和婴儿的生命。

项目成果

Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey.

• DOI: 10.1136/bmjopen-2018-022583
• 发表时间: 2018-11-08
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Altijani N;Carson C;Choudhury SS;Rani A;Sarma UC;Knight M;Nair M
• 通讯作者: Nair M

Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study

• DOI: 10.1002/ijgo.15367
• 发表时间: 2024-01-17
• 期刊: INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
• 影响因子: 3.8
• 作者: Boo，Yebeen Ysabelle;Bora，Amrit K.;Nair，Manisha
• 通讯作者: Nair，Manisha

Abortion decision-making process trajectories and determinants in low- and middle-income countries: A mixed-methods systematic review and meta-analysis.

低收入和中等收入国家的堕胎决策过程轨迹和决定因素：混合方法系统的审查和荟萃分析。

• DOI: 10.1016/j.eclinm.2022.101694
• 发表时间: 2022-12
• 期刊: ECLINICALMEDICINE
• 影响因子: 15.1
• 作者: Lokubal, Paul;Corcuera, Ines;Balil, Jessica Macias;Frischer, Sandrena Ruth;Kayemba, Christine Nalwadda;Kurinczuk, Jennifer J.;Opondo, Charles;Nair, Manisha
• 通讯作者: Nair, Manisha

Abortion decision-making trajectories and factors influencing such trajectories in low- and middle-income countries: a protocol for mixed-methods systematic review.

• DOI: 10.1136/bmjopen-2021-049507
• 发表时间: 2021-11-01
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Lokubal P;Frischer SR;Corcuera I;Balil JM;Nalwadda Kayemba C;Kurinczuk JJ;Nair M
• 通讯作者: Nair M

Systematic review and meta-analysis of prolactin and iron deficiency in peripartum cardiomyopathy.

• DOI: 10.1136/openhrt-2020-001430
• 发表时间: 2020-10
• 期刊: Open heart
• 影响因子: 2.7
• 作者: Cherubin S;Peoples T;Gillard J;Lakhal-Littleton S;Kurinczuk JJ;Nair M
• 通讯作者: Nair M