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

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。印度的产妇死亡率是所有国家中最高的。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，但每天都有6名孕妇死亡。除死亡外，印度约有500万孕妇患有危及生命的并发症。因此，必须对这些并发症进行调查，以改善产妇健康。这样做的一个起点是确保准确识别孕产妇死亡和严重并发症，以便对它们进行研究。我已经在阿萨姆邦的两家教学医院测试了这项工作的可行性，在那里我成功地收集了22,000多名妇女的信息。我将把这一方法(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，这将使每年能够收集关于100,000次分娩的信息。这一方法使用了一个名为“印度母婴健康研究合作(MaatHRI)”的“研究平台”，将为今后研究其他邦的孕产妇健康提供一个模式。在印度，贫血是导致产妇死亡的重要原因。在我最初的工作中，我发现，在一年多的时间里，母亲死亡的一半是由于贫血心力衰竭，三分之一是由于分娩时严重出血，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，关于母亲贫血心力衰竭的文献很少，所以我们不知道是什么个人因素导致了这种疾病，也不知道为什么一些妇女死于这种疾病，而另一些人没有。同样，我们需要更多关于贫血妇女引产和刺激分娩安全性的信息。由于这两个方面是最重要的，我将首先使用MaatHRI进行调查，我将(1)比较两组患有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，以了解其临床特征和导致心力衰竭的因素；(2)我将促进专家审查患有心力衰竭的妇女的妊娠护理笔记样本，以确定导致一些妇女死亡的因素和挽救另一些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，来研究在贫血妇女中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。研究结果将被用于指导(1)贫血性心力衰竭的预防和治疗，以及(2)贫血孕妇引产或刺激分娩的安全性。我将通过在4-5年内举办三个研讨会来做到这一点。这将与传播成果和鼓励将MaatHRI扩大到其他医院和州的计划一起进行(目标4)。最后，我将利用MaatHRI(目标5)为这一奖学金的后续研究制定建议。将探讨传染病作为危险因素对母亲和婴儿的健康和福祉的作用。为此，将在第四年开始对孕妇的传染病进行调查。此外，我还将在我早期工作中发现有问题的其他领域设计研究，即：子痫、败血症和子宫破裂。综上所述，这项工作将(1)建立一个亟需的研究‘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(首先是贫血妇女的心力衰竭和引产的安全性)；(3)制定可以在未来测试和实施的指导和干预措施，以挽救母婴的生命。

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.