Amanda Henry: improving women's health on World Preeclampsia Day
Meet Dr Amanda Henry, Senior Research Fellow, Women’s Health.
How long have you been working at The George Institute?
Since January this year (2018).
What attracted you to working here?
First and foremost, the George Institute's new Global Women's Health program. With my clinical background as an obstetrician, and my research focus in Women's Health, it's really exciting to be part of an evolving program in the area I'm passionate about, particularly when it's with a leading research institute like the George. Also, I'm used to working collaboratively, and since UNSW is both my main employer and the Sydney academic partner of the George Institute, it's great to have an opportunity to bring together George Institute and UNSW researchers to further work in Women's Health. The enthusiasm and drive of the George Institute staff is amazing!
Another big attraction for me is the opportunity to work in an institute that has such an incredible track record in doing large-scale, impactful work that actually manages to translate from concept to clinical trial and then on into practice.
What is your area of research and how does it help people lead healthier lives?
Complicated pregnancy generally, but now more specifically preeclampsia and other hypertensive disorders of pregnancy, and how having had a pregnancy complicated by high blood pressure increases a woman's risk of developing cardiovascular disease. My NHMRC Early Career Fellowship that I have just commenced encompasses a longitudinal study identifying markers of increased cardiovascular risk in the first 5 years after hypertensive pregnancy, work with women and healthcare practitioners around what are the knowledge gaps about hypertensive pregnancy and long-term risk of cardiovascular disease (and how to close those gaps), and also a planned intervention study focussing on lifestyle behaviour change after hypertensive pregnancy to reduce risk. The ultimate aim is to improve women's long-term cardiovascular health and live healthier lives through identifying the risks that their complicated pregnancy has exposed and working with women to decrease that risk.
World Preeclampsia Day is on 22 May. What is preeclampsia and how many people get it?
Preeclampsia is a multisystem disorder of pregnancy, that is most often recognised clinically as high blood pressure and excess protein in the urine during the second half of pregnancy, however it can have major effects on many maternal organ systems (e.g. kidneys, liver, brain, lungs) and also on the growth of the baby.
About 1 in 10 pregnant women will have high blood pressure in pregnancy, and about 1 in 30 will get preeclampsia. In Australia, that means about 10,000 women a year have preeclampsia. It is a leading cause both locally and globally of severe maternal disease and death, and of premature birth. Globally, about 75,000 mothers and half a million babies lose their lives each year due to preeclampsia, and 99% of these deaths occur in low and middle income countries.
Is there a link between preeclampsia and noncommunicable diseases?
Absolutely. Although the short term consequences of preeclampsia can be devestating, from a public health perspective the long-term associations with preeclampsia and an increased risk of cardiovascular disease may be even more serious. There is now a large body of epidemiological data that shows a history of preeclampsia is associated with at least a doubling in a woman's long-term risk of heart attacks, stroke, and vascular disease, and a 3 to 4 fold increase in chronic hypertension. Although kidney failure is overall a much rarer condition, if a woman has had preeclampsia her risk of long-term kidney disease is up to 10 times higher than a woman who did not have hypertensive pregnancy. Also, the studies are not suggesting that these risks are "old age" risks, this is risk of premature NCD disability and death: most of the studies are looking at women only 8 to 25 years after pregnancy.
How can we prevent or treat preeclampsia?
Ideally prevention starts before actually getting pregnant, with women being a normal weight, adopting a healthy diet, and anyone with a chronic medical problem getting it as well controlled as possible before getting pregnant. In practice of course that doesn't necessarily happen.
The next prevention is aspirin and calcium tablets. Although research is ongoing into how effective it is in real-world scenarios, and what is the most cost-effective way to identify “high-risk” women, aspirin given to women at high risk of getting preeclampsia (such as those who have a previous history) from about 12 weeks of pregnancy definitely decreases the risk of developing preeclampsia. Calcium supplementation, particularly in women from nutritionally deficient areas or who have low dietary calcium, also appears to lower the risk of developing preeclampsia. So identifying high-risk women and commencing aspirin and calcium from early pregnancy is a major prevention strategy.
Then unfortunately at this stage there’s not much more we can do to prevent preeclampsia, although various trials of potential medications are in place or planned. To at least make sure women are identified early, hopefully before a major complication such as an eclamptic seizure or kidney failure occurs, ensuring all women have regular pregnancy care including a blood pressure check, is vital. In fact, the current schedule of pregnancy care, with increasing visits later in pregnancy, really centres on identifying women developing preeclampsia who are unaware of it because they have no symptoms or only mild symptoms.
Once preeclampsia develops, although the high blood pressure aspect can usually be controlled (at least for a while) with medication, the only real treatment for preeclampsia is delivery. If the woman is already close to her due date when she develops preeclampsia, that’s usually not such a major issue – although both mother and baby can still get quite sick either before or after the birth – but if the baby is still quite preterm that can make for some very tough decisions.
Then after the baby is born, it's very important to keep a close watch on mum for at least the first few days, as some women will actually have their worst complications from preeclampsia in the postpartum period. It’s also vital to think about future pregnancies, where women have a higher risk of recurrent preeclampsia, and long-term, making sure women are followed up to discuss their risks after preeclampsia and that a healthy lifestyle and minimising NCD risk factors is encouraged.
What motivates you most in your work?
I don’t think there’s any one “most”, it’s the mixture of clinical, teaching, and research work that motivates me.
Being a clinician was where it started for me, and I still am very motivated by working with women and their families, and making a difference day to day in my clinical work. The education I do with university students and postgraduate obstetrics and gynaecology trainees is another huge motivator: that work is with an eye to the next generation, ensuring our doctors and other health professionals are well equipped to deliver excellent care in Women’s Health. And then research is the long game: maybe, just maybe, I will be able to make a difference, however small, to every generation to come through my research.
How did your career in health get started?
I must ‘fess up here that I come from a medical background: both my parents are doctors! I actually spent most of high school saying I would never become a doctor though: I wanted to do something different. It was only when I really thought it through in Year 12 that I realised Medicine actually was what I was looking for – a field with huge scope, and with a great mixture of science and humanity. Then in terms of Women’s Health, when I saw my first baby being born during medical school, it was the most magical thing I had been involved with up to that point and I was hooked!
To explain to people what I do I say…
Hmmm. That’s a tough one! It sort of depends which of my “hats” I’m wearing. To most people I would introduce myself as an obstetrician by background, with a particular focus on high-risk pregnancy, and that I work as a Clinical Academic, researching and teaching at UNSW and in hospitals, and also for the George Institute for Global Health’s new Global Women’s Health program. That usually leads to more questions (like “what is a Clinical Academic?” – nobody knows!) and detailed explanations; and quite often to someone’s birth stories also!
