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NICE guidance recommends fewer but earlier antenatal check ups

BMJ 2003; 327 doi: (Published 30 October 2003) Cite this as: BMJ 2003;327:1009
  1. Mayor Susan
  1. London

    Healthy women with uncomplicated pregnancies should have fewer but more informative antenatal check ups, says new evidence based guidance, published last week, on the routine care of pregnant women.

    The guidance, from the National Institute for Clinical Excellence, recommends that healthy women should typically be offered 10 appointments during first pregnancies and seven during subsequent pregnancies, rather than the current average of around 14.

    The guidance, which applies to the NHS in England and Wales, suggests that appointments—although fewer—should start earlier in pregnancy. Most women currently see a doctor at around 12 weeks, but the guidance says that seeing a health professional earlier, at around eight weeks, would give women more time to make decisions about screening and to plan what kind of care they want during their pregnancy.

    All women should be given ultrasonography at 10 to 13 weeks to estimate when their baby is due, instead of having the date estimated from the date of their last period. This should improve the accuracy of pregnancy staging and reduce the number of women whose labour is inappropriately induced at 41 weeks.

    The guideline is the first major change to the basic pattern of antenatal care since the 1920s and is based on a review of all relevant evidence.

    Jane Thomas, director of the National Collaborating Centre for Women's and Children's Health, the group that developed the guidance for NICE, said: “It is important that there is a clearly defined purpose to every antenatal appointment offered to women. The pattern of antenatal care has evolved over the last 80 years, but it has been based on ritual and has not always had a scientific basis.

    “This guideline outlines a more appropriate pattern of care for the 21st century—one that is evidence based. It focuses on the quality of appointments, rather than quantity, and will avoid women's time being wasted by unnecessary appointments. Fewer visits may also help improve continuity of care and have a beneficial impact on pregnancy outcome.”

    The guidance supports a previous recommendation that all pregnant women should be offered screening for Down's syndrome, whatever their age, rather than restricting testing to women over a particular age, but it leaves NHS trusts free to determine their own policies on the type of tests they offer.

    It also advises that routine screening for diabetes during pregnancy is not justified and should be carried out only as part of research studies. This advice is based on the recognition that dipstick testing of urine for diabetes lacks adequate sensitivity and specificity. It also reflects the lack of evidence that intervening in gestational diabetes prevents the development of type 2 diabetes in the woman or alters the effect on the baby.

    The guidance on antenatal care is the first in a series that will be published by NICE aimed at improving maternity services and standardising care across the NHS in England and Wales. Further guidelines are being developed on caesarean section, care during labour, postnatal care, and postnatal depression.

    Antenatal Care: Routine Care for the Healthy Pregnant Womanis available at from the NHS response line, tel 0870 1555 455, by quoting reference NO309.

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