Using pregnancy to improve women’s lifelong health

By utilising a life-course approach to the prevention of non-communicable diseases, when women are screened during pregnancy.

The physiological changes in a woman’s body during pregnancy to support fetal growth and wellbeing and prepare for labour and birth have been compared to a nine-month marathon that finishes with a sprint. For some women, this pregnancy “stress test” will result in medical complications of pregnancy, such as gestational diabetes (“GDM”, affecting approximately 1 in 7 pregnancies globally), high blood pressure disorders (affecting up to 1 in 10 pregnancies globally) and anaemia (10-40%). Existing mental and physical health conditions may also worsen.

The course of a woman’s pregnancy also gives a window into a woman’s future health, as the effect of pregnancy complications on mother and child do not end with the pregnancy. For example, after hypertensive pregnancy there is at least doubled risk of cardiovascular disease (beginning within 5-10 years of affected pregnancy as shown by our own researchers ) and Type 2 diabetes, triple the risk of chronic hypertension, and 5-10 times the risk of chronic kidney disease. After GDM the risk of Type 2 diabetes is increased on average 7-fold, again with effects often seen soon after affected pregnancy: the George Institute-led LIVING study found that over a third of South Asian women participating in the trial had evidence of pre-diabetes in the first year after giving birth.

Fortunately, pregnancy and childbirth are a time when the vast majority of women in both low-middle and high-income countries access healthcare, so is an ideal time to screen women for both pre-existing conditions (such as anaemia, chronic hypertension, pre-pregnancy diabetes, and anxiety/depression) and then to monitor for pregnancy complications that can impact both short and long-term maternal health. However, to maximise the impact of pregnancy screening and use the knowledge gained to improve women’s health across the lifecourse , care needs to continue postpartum, with implementation of early interventions after birth and improvement in healthcare systems currently focussed only on pregnancy, birth, and immediately postpartum.

Women’s Health Program researchers and their global collaborators are leaders in investigating and implementing pregnancy and postpartum interventions to improve women’s life-course health and prevent non-communicable disease. Recent and current projects include:

• SMARTHealth Pregnancy, led by Professor Jane Hirst and Associate Professor D Praveen, which helps community health workers in India identify women at risk during pregnancy and manage their healthcare in order to improve pregnancy outcomes and prevent future health complications.
• The Closing Knowledge Gaps after Hypertensive Pregnancy program, led by Professor Amanda Henry. The George Institute collaborators and team members include Dr Megan Gow and Associate Professor Clare Arnott. This program includes early-intervention trials (Blood Pressure Postpartum, BP2), implementation/systems change projects centred on both women and primary healthcare professionals regarding follow-up after hypertensive pregnancy, and investigating mental health after hypertensive pregnancy (PhD candidate Jie Shang, supervisors Prof Henry, Dr Katie Harris, Prof Maree Hackett).
• The LIVING study, randomised trial of follow-up and lifestyle behaviour change in South Asian women after gestational diabetes, led by a team including Prof Anushka Patel, which found high rates of pre-diabetes soon after pregnancy that were not improved by the lifestyle intervention, suggesting need for additional strategies.
• DIVINE-NSW and DIVINE-pilot, with The George Institute team including Prof Anushka Patel, A/Prof Clare Arnott, Prof Amanda Henry, Dr Vivan Lee, Dr Angela Chen. Following on from the LIVING findings, we have investigated pre-diabetes prevalence and risk factors in a metropolitan Australian population shortly after GDM, and are commencing trials of preventive medication in this population.
• Preeclampsia prediction study (Dr Katie Harris, Prof Mark Woodward, Prof Jane Hirst, Prof Amanda Henry) investigating utility of blood pressure and risk factor markers in predicting the hypertensive disorder of pregnancy, preeclampsia.
• Produce Prescription in Pregnancy (led by Prof Jason Wu from Food Policy, Women's Health Program collaborators/staff Prof Amanda Henry and Dr Megan Gow), investigating the role of providing healthy food for reducing the risk of gestational diabetes in high-risk populations who also experience food insecurity