ANTENATAL CARE:

1

• ANTENATAL CARE
• ROUTINE CARE FOR THE HEALTHY PREGNANT WOMAN an
  update
• Educational Launch Meeting
• NICE Guideline 14 April 2008
• Professor Robert Shaw
• Chair Board NCC-WCH

2
Maternity Care

• Tremendous improvement in SB and NND rates over
  last 50 years
• Increased expectancy for survival of very
  premature babies at lower gestations
• Safer for mothers to undergo pregnancy and
  childbirth
• Result of developments and changes in
  interventions in pregnancies often where
  complications are present

3
Antenatal Care

• Involves many health care professionals giving
  care and advice co-ordination
• Monitors pregnancy to confirm normal progression
• Opportunity to identify abnormalities at an early
  time to ensure changes to antenatal care protocols

4

• Modern ANC also offers interventions/
  investigations to identify abnormalities in
  mother or fetus
• Gives an opportunity to provide Public Health
  advice on diet and lifestyle issues which can
  influence pregnancy outcome

5
Antenatal Information

• Pregnant women should be offered information
  together with support to enable them to make
  informed decisions about their care, where and by
  whom

6
Lifestyle Considerations

• New recommendations on
• ALCOHOL CONSUMPTION
• VIT D INTAKE

7
Department of Health Advice

• The Department of Health advises that pregnant
  women or women trying to conceive should avoid
  drinking alcohol. If they do choose to drink, to
  minimise the risk to the baby, they should not
  drink more than one to two units of alcohol once
  or twice a week and should not get drunk
• National Collaborating Centre for
• Womens and Childrens Health

8
Evidence Base

• Low-to-moderate alcohol intake
• Possibly a slight increase in miscarriage,
  especially in first three months of pregnancy
• National Collaborating Centre for
• Womens and Childrens Health

9
Recommendations

• Women should be advised to drink no more than 1-2
  units 1-2 times per week
• Women should be informed that getting drunk or
  binge drinking (defined as more than 7.5 UK units
  on a single occasion) may be harmful to the baby
• Women planning pregnancy should be advised to
  avoid drinking alcohol in the first three months
  if possible as it may be associated with an
  increased risk of miscarriage
• National Collaborating Centre for
• Womens and Childrens Health

10
Vitamin D Evidence Base

• The GDG identified the following groups as
  vulnerable to vitamin D deficiency
• Women in low income households
• Asian and Black women
• Women with low intake of dietary source of
  vitamin D such as full fat dairy products, eggs,
  animal products
• Women 19-24 years of age
• Women who have limited skin exposure to sunlight
• Women who are obese
• National Collaborating Centre for
• Womens and Childrens Health

11
Antenatal Care (update) Guidance

• All women should be informed at booking of the
  importance for their own and babys health of
  maintaining adequate vitamin D stores during
  pregnancy and whilst breastfeeding.
• In order to achieve this, women may choose to
  take a vitamin D supplement (Healthy Start
  multivitamins)
• National Collaborating Centre for
• Womens and Childrens Health

12
Antenatal Care (update) Guidance

• Professionals should enquire as to whether women
  at risk are following advice to take a vitamin D
  supplement
• Women of South Asian, African, Caribbean or
  Middle Eastern origin
• Women who have limited exposure to sunlight
• Women who eat a diet low in vitamin D (no oily
  fish, eggs, meat, margarine or breakfast cereal)
• Women with a BMI greater than 30
• Women aged 19-24 or those in low income household
• National Collaborating Centre for
• Womens and Childrens Health

13
Public Health Guidance

• At booking Midwives should offer every woman info
  and advice on benefits of taking a vitamin D
  supplement during pregnancy and whilst breast
  feeding
• They should explain that this will increase
  mother and babys vitamin D stores and reduce the
  babys risk of developing rickets
• National Collaborating Centre for
• Womens and Childrens Health

14
Screening for Gestational Diabetes

• Does it matter?
• Whats the best method?
• Whats the cost/resource implications?
• Acceptability to women?
• National Collaborating Centre for
• Womens and Childrens Health

15
Does it

• Evidence shows slightly raised risk of birth
  complications with a macrosomic baby
• Some evidence indicates universal screening
  detects more cases than risk factor screening and
  improves outcomes
• Need to consider factors beyond the simple numbers

16
Screening for Gestational Diabetes

• Screening using risk factors recommended in a
• healthy population
• BMI above 30kg/m2
• Previous macrosomic baby (gt4.5kg)
• Previous Gest. Diabetes
• FH of diabetes (1o relative)
• Family origin with high prevalence
• Oral GTT at 24 weeks

17
Screening for Haematological Conditions

• Screening for sickle cell disease and
  thalassaemia should be offered as early as
  possible in pregnancy. Type of screening depends
  on prevalence

18
Screening for Downs Syndrome

• UK incidence about 1.1/1000 births
• Intellectual impairment in about 80
• Structural abnormalities Cardiac about 40
• Later life problems leukaemia, thyroid
  disorders, Alzheimers disease
• National Collaborating Centre for
• Womens and Childrens Health

19
Screening for Downs Syndrome

• 11 to 136 weeks
• Nuchal translucency (NT)
• Combined test (NT hCG PAPP-A)
• 15 to 20 weeks
• Triple test (hCG, uE3, AFP)
• Quadruple test (hCG, uE3, AFP, inhibin A)