KEY PRIORITIES FOR IMPLEMENTATION
- Antenatal information – offer women evidence-based information and support them in making informed decisions about their care. The guidance specifies what information should be given, and when and how it should be given.
- Lifestyle considerations – inform women at booking appointment about the importance of maintaining adequate vitamin D stores during pregnancy and while breastfeeding. Women may choose to take a 10 microgram daily supplement. Those at greatest risk of vitamin D deficiency include:
- women of South Asian, African, Carribean or Middle Eastern family origin
- women who have limited exposure to sunlight
- women who eat a diet particularly low in vitamin D
- those with a pre-pregnancy BMI >30kg/m2
- Screening for haematological conditions – offer screening for sickle cell diseases and thalassaemias as early as possible, ideally by 10 weeks.
- Screening for foetal anomalies – offer all women screening for Down’s syndrome. Offer the ‘combined test’ (nuchal translucency, beta-human chorionic gonadotrophin, pregnancy-associated plasma protein-A) between 11 weeks and 13 weeks six days or the serum screening test between 15 and 20 weeks. Offer all women an ultrasound scan for structural anomalies, normally between 18 weeks and 20 weeks six days.
- Screening for clinical conditions – determine risk factors for gestational diabetes at booking appointment.
Offer testing to women with any risk factor.
Other new recommendations include:
- Gestational age assessment – offer women an early ultrasound scan between 10 weeks and 13 weeks six days to determine gestational age and to detect multiple pregnancies.
- Alcohol consumption – advise women to avoid alcohol during the first three months of pregnancy. Advise those who choose to drink to limit their intake to no more than 1—2 units once or twice a week. Advise women that getting drunk or binge drinking (>7.5 units on a single occasion) may be harmful to the unborn baby.
The guidance also contains new or updated recommendations on smoking cessation, mental health, screening for asymptomatic bacteriuria, chlamydia, pre-eclampsia and placenta praevia, and monitoring foetal growth and well-being.
The full guideline is available at www.nice.org.uk