SMART Health Pregnancy: An opportunity to improve women's lifelong health

A collaborative project with the George Institute for Global Health (India). It aims to strengthen antenatal and postnatal care delivery for women living in rural India. Common complications that develop during pregnancy are well-known to increase risks during pregnancy, with some conditions such as gestational diabetes and preeclampsia greatly increasing a woman's risk of type 2 diabetes or hypertension after birth. This program has been designed to try and break this cycle.

Following detailed development work and a pilot study (led by Dr S Nagraj, DPhil 2021), a complex intervention has been developed for women during pregnancy and in the first year after birth targeting the major complications of pregnancy: anaemia, hypertension and diabetes. Current work focusses on integrating a new program to support perinatal mental health into this platform (the PRAMH study).

SMART Health Pregnancy enables frontline health workers (ASHA workers) to first register all pregnant women in their village using a secure tablet/smartphone App. They are then trained to ask simple screening questions and perform point-of-care tests (Hb, blood sugar, BP). Within the App, a clinical decision support algorithm then produces a recommendation, with e-referral to primary care if indicated. The primary care doctor is supported with a complimentary App, giving guideline-based management and prescribing advice. Finally, there is communication back to the ASHA worker via 3G/4G to ensure follow-up and medication adherence. The ASHA workers assess each woman several times during pregnancy and in the first six weeks after birth. Uniquely, the program then offers ongoing wellbeing checks timed with infant immunisations in the year after birth, to detect any ongoing complications such as anaemia, diabetes and hypertension that could affect future pregnancies or wellbeing.

A cluster randomised trial in 60 villages across Telangana and Haryana is currently being conducted. This will determine if SMART Health Pregnancy can improve health outcomes and engagement with care. For further information please contact Professor Jane Hirst.