Improving women's lifelong health after high-risk pregnancy

心血管疾病，如中风和心脏病发作，是全球妇女死亡的主要原因。心血管疾病高危妇女的一个特殊群体是那些经历妊娠合并妊娠糖尿病（GDM）和/或妊娠高血压疾病（HDP）的妇女。妊娠期受GDM影响后，5年内高达50%的妇女将发展为2型糖尿病；HDP之后，30%的女性会患上高血压。这两种情况都大大增加了心血管疾病的风险，但及时发现和管理这些风险可以大大降低。打破高危妊娠和心血管疾病之间这种联系的重要性已得到广泛承认，但迄今为止，还没有试验证明可以实现这一目标，更重要的是，它是否可以在经济上和规模上实现。需要采取三项关键行动：(i)有效的初级预防；（二）定期筛查，（三）在发现疾病时进行循证管理。印度正在经历2型糖尿病和高血压的流行。7300万人患有糖尿病，2.07亿人患有高血压（2017年数据）。GDM和HDP的发生率很高，分别影响20%和10%的妊娠。迫切需要制定有效和负担得起的预防战略，以减少这些疾病对印度妇女造成的经济、社会和健康后果。在英国，GDM和HDP是最常见的妊娠并发症。妊娠期GDM后，女性应在出生后6周接受GP筛查，以确定是否存在持续性高血糖。然而，出勤率普遍较低，全国的出勤率在30-70%之间。遵循HDP，需要证据来指导护理。该奖学金将使我能够在印度和英国这两个国家领导相关的工作项目，确定数字创新在为全球妇女提供产后干预方面可能发挥的作用。我将进行两项临床研究，并在整个奖学金期间积极参与政策制定者、临床医生、数字医疗公司和社会企业。SMART Health是一个数字平台，由乔治全球健康研究所开发，已在印度、印度尼西亚、中国和缅甸实施，以改善糖尿病和高血压的检测和管理。该平台面向农村社区卫生工作者和初级保健医生，支持任务转移、临床决策支持、自动转诊、短信提醒和患者跟踪。自2017年以来，我一直领导小组调整该平台，以改善印度农村孕妇贫血，GDM和HDP的检测和管理：SMART Health Pregnancy （SHP）。通过这个奖学金，我将扩展SHP，以促进妊娠合并GDM和/或HDP后的高血压和2型糖尿病的预防、筛查和早期治疗。在印度农村进行的一项大型临床试验中，将对960名妇女进行为期5年的随访，以评估这种方法对高危妊娠后实现目标血压和血糖控制的影响。在英国，我是牛津大学临床医生和研究人员团队的一员，他们为患有GDM的女性开发了一个远程监测系统（GDmHealth）。我们在一项临床试验中证明，这种方法安全、方便，受到妇女和卫生工作者的青睐。2018年，这项技术被授权给一家商业公司（Sensyne），从那以后，英国各地成千上万的女性从这项创新中受益。通过这项奖学金，我将领导一项工作计划，将这种方法应用于出生后一年的女性，评估远程监测是否提高了筛查出勤率，提供了有效的生活方式支持，为NHS提供了潜在的成本节约，同时为新妈妈们提供了可接受和更方便的服务。他们的方法可以改善他们的健康，为未来的怀孕和生命

Cardiovascular diseases (CVDs), such as strokes and heart attacks, are the leading causes of death amongst women globally. A particular group of women at high risk of cardiovascular disease are those who experience a pregnancy complicated by gestational diabetes mellitus (GDM) and/or a hypertensive disorder of pregnancy (HDP). Following a pregnancy affected by GDM, within 5 years up to 50% of women will develop T2DM; and following HDP, 30% of women will develop hypertension. Both these conditions greatly increase risk for CVD, however with timely detection and management these risks can be greatly reduced. The importance of breaking this link between high-risk pregnancy and CVD is widely acknowledged, yet to date there have been no trials demonstrating this can be achieved, and importantly whether it can be done affordably and at scale. Three key actions are needed: (i) effective primary prevention; (ii) regular screening, and (iii) evidence-based management when disease is detected. India is experiencing an epidemic of type 2 diabetes mellitus (T2DM) and hypertension. 73 million people have diabetes, and 207 million hypertension (2017 data). Rates of GDM and HDP are high, affecting 20% and 10% of pregnancies, respectively. There is an urgent need for effective and affordable preventative strategies to reduce the economic, social and health consequences of these conditions for women in India. In the UK, GDM and HDP are the commonest complications of pregnancy. After a pregnancy with GDM, women should undergo screening with their GP 6 week after birth for persistent high blood glucose. Attendance however is generally poor, with rates between 30-70% across the country. Following HDP, evidence is needed to guide care. The Fellowship will enable me to lead connected programs of work across two countries: India and the UK, determining the role digital innovations could play to deliver post-partum interventions in women globally. I will conduct two clinical studies, with active engagement with policy makers, clinicians, digital health companies and social enterprises throughout the Fellowship.SMART Health is a digital platform, developed by the George Institute for Global Health, that has been implemented in India, Indonesia, China, and Myanmar, to improve detection and management of diabetes and hypertension. The platform is aimed at rural community health workers and primary care doctors, enabling task shifting, clinical decision support, automated referral, SMS reminders, and patient tracking. Since 2017, I have been leading the group adapting this platform to improve the detection and management of anaemia, GDM and HDP in pregnant women living in rural India: SMART Health Pregnancy (SHP). Through this Fellowship I will extend SHP to facilitate prevention, screening, and early treatment of hypertension and T2DM in the years after a pregnancy complicated by GDM and/or HDP. The effect of this on achieving target blood pressure and blood glucose control after high risk pregnancy will be assessed in a large clinical trial in rural India, following 960 women for 5 years.In the UK, I was part of the team of clinicians and researchers in Oxford who developed a remote monitoring system for women with GDM (GDmHealth). We demonstrated in a clinical trial that this approach was safe, convenient and preferred by women and health workers. The technology was licensed to a commercial company (Sensyne) in 2018, and since then thousands of women have benefited from this innovation across the UK. Through this Fellowship I will lead a program of work adapting this approach for women in the year after birth, assessing whether remote monitoring improves screening attendance, deliver effective lifestyle support, offer a potential cost savings to the NHS, whilst being acceptable and more convenient for new mums. Theis approach could improve their health, for future pregnancies and lifelon