Improving women's lifelong health after high-risk pregnancy

Women's health is more than reproductive health. Globally, non-communicable diseases (NCDs), such as cardiovascular disease, cancer and diabetes are the leading causes of death and disability for women however, health care for women remains focussed largely on pregnancy care and contraception. My fellowship focusses on three pressing global priorities in women's health: (1) using pregnancy as an opportunity to improve lifelong health, (2) developing AI tools to improve care delivery, health equity and outcomes for women across the life course, and (3) understanding the effects of climate change on women's health.

Conditions detected during pregnancy, such as gestational diabetes mellitus (GDM) and preeclampsia identify women at greatly increased risk of type 2 diabetes or hypertension in the months and years immediately after the birth. We have developed and tested a novel, low-cost approach to improving women's lifelong health by integrating NCD screening into pregnancy and postnatal care (SMARThealth Pregnancy). We are conducting a large trial across two states in India that has recruited 3400 pregnant women, 240 community health workers, and thirty primary care doctors from 60 villages. The trial is testing a digital intervention to support community health workers (known as ASHA in India) detect, refer and follow-up of women with high risk pregnancy conditions. The comparator is usual care. The trial is ongoing and results are expected by mid 2025. Working with data scientists at the George Institute for Global Health and University of Oxford, and the community health workers in the SMARThealth Pregnancy sites, we have co-developed a large language model (LLM) chatbot to support the ASHAs deliver guideline based care. We are exploring ways to ensure our AI tools are equitable and gender transformative. A major challenge in our study sites is the lack of services to detect and manage women's mental health problems. Globally one in five women will suffer a mental health problem around the time of birth, yet most women lack access to any evidence-based support or therapy. Sadly, suicide is a leading cause of late maternal death (i.e. death up to one year after birth). We are co-developing an intervention to support women's perinatal mental health (PRAMH).

Improving care after high-risk pregnancy is not a problem limited to India. In the UK, access and quality of post partum care is uneven across the country. With an increasing volume of digital data from electronic health records and individual patient sensors (such as digital blood glucose monitoring), our team are working the utilise data to transform care. Our aim is to move from a "one size fits all" approach, to personalised and targeted care that will prevent future disease, and be more efficient to delivery within the NHS. I have established a national data consortium for gestational diabetes, and we work with data scientists who are developing and validating prediction models and LLM suitable for the UK. We plan to test and scale a model to improve the care of women after GDM in the next three years.

The final aspect of my Fellowship addresses the global challenge of climate change and how this is affecting women's health. The effects of climate change are not gender neutral, yet data is lacking to measure and track these differences in most settings. 2023 is the hottest year on record and has had direct and indirect effects on human health. Heat is associated with preterm birth, stillbirth, preeclampsia and other adverse outcomes. Women in rural India are some of the most at risk from the effects of climate change, with many working outdoors with few opportunities for adaptation. Together with our partners from the SMARThealth Pregnancy project, and with other experts from the UK and India, we are exploring how extreme heat leads to adverse pregnancy outcomes, and working with communities to identify locally appropriate opportunities for adaptation.