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

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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.