Improving women's lifelong health after high-risk pregnancy

中风和心脏病等心血管疾病(CVD)是全球女性死亡的主要原因。心血管疾病高危妇女的一个特殊群体是那些经历了妊娠合并妊娠期糖尿病(GDM)和/或妊娠高血压疾病(HDP)的妇女。妊娠合并妊娠期糖尿病后，5年内高达50%的妇女将发展为T2 DM；HDP之后，30%的妇女将发展为高血压。这两种情况都极大地增加了心血管疾病的风险，但如果及时发现和管理，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得到了广泛的承认，但到目前为止，还没有试验证明这一点可以实现，重要的是是否可以负担得起和大规模地完成这项工作。需要采取三项关键行动：(1)有效的初级预防；(2)定期筛查；(3)在发现疾病时采取循证管理。印度正在经历2型糖尿病(T2 DM)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)。妊娠期糖尿病和HDP的发病率很高，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，妊娠期糖尿病和HDP是最常见的妊娠并发症。在妊娠合并妊娠期糖尿病后，妇女应该在出生后6周接受全科医生筛查，以确定是否存在持续性高血糖。然而，上座率总体上很低，全国的上座率在30%-70%之间。在HDP之后，需要证据来指导护理。该奖学金将使我能够领导两个国家的互联工作计划：印度和英国，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，与政策制定者、临床医生、数字健康公司和整个基金的社会企业积极参与。SMART Health是由乔治全球健康研究所开发的数字平台，已在印度、印度尼西亚、中国和缅甸实施，以改进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，我一直在领导一个小组，采用这一平台来改进印度农村孕妇贫血、GDM和HDP的检测和管理：智能健康怀孕(SHP)。通过这一奖学金，我将扩大SHP，以促进在妊娠合并妊娠期糖尿病和/或HDP后的几年内预防、筛查和早期治疗高血压和T2 DM。在印度农村对960名妇女进行为期5年的大型临床试验，将评估这种药物在高危妊娠后实现目标血压和血糖控制方面的效果。在英国，我是牛津大学临床医生和研究人员团队的一员，他们为妊娠期糖尿病妇女开发了远程监测系统(GDmHealth)。我们在临床试验中证明，这种方法是安全、方便的，而且受到妇女和卫生工作者的青睐。这项技术于2018年被授权给一家商业公司(Sensyne)，自那以后，英国各地数千名女性从这项创新中受益。通过这个奖学金，我将领导一个工作计划，为出生后一年的女性调整这种方法，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，同时对新妈妈来说是可接受的和更方便的。这一方法可以改善她们的健康，为未来的怀孕和终生做准备

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