Antenatal careImplementing NICE guidance

Slide Set 2011 (2nd Edition)

NICE clinical guideline 62

What this presentation covers

Updated recommendations

Key priorities for implementation

Costs and savings

Discussion

NICE Maternity Pathway

NHS Evidence

Find out more

Updated guidance

This guideline replaced

‘Antenatal care: Routine care for the healthy pregnant woman’

(NICE clinical guideline 6, 2003)

Updated recommendation; alcohol consumption

•Advise women to avoid alcohol in first 3 months of

pregnancy if possible

•If women choose to drink alcohol they should be

advised to drink no more than 1 to 2 UK units once

or twice a week

•Women should be informed that getting drunk or

binge drinking during pregnancy may be harmful

•This advice is consistent with the advice issued

in 2007 by the UK Chief Medical Officers

Updated recommendation:quitting smoking in pregnancy

• This guideline was amended following the release of the NICE public health guidance PH26 “Quitting smoking in pregnancy and following childbirth”.

• Reducing smoking is no longer recommended for pregnant women who are attempting to quit.

• Women should be advised to stop smoking completely, rather than cutting down (NICE PH26)

Key priorities for implementation

•Providing antenatal information•Lifestyle considerations (vitamin D)•Screening for haematological

conditions•Screening for fetal anomalies •Screening for clinical conditions

(gestational diabetes)

• Offer information based on the current available evidence:

– At first contact– At the booking appointment (ideally

by 10 weeks)– Before or at 36 weeks– At 38 weeks

• Support women to make informed decisions relating to care pathway

Providing antenatal information

Lifestyle considerations (vitamin D)

At the booking appointment inform all women:

• of the need for adequate vitamin D stores during pregnancy and whilst breastfeeding

• that taking 10 mcg daily, as found in the Healthy Start multivitamin, can help achieve adequate

stores

Enquire whether women at greatest risk of deficiency are following the advice

Screening for haemoglobinopathies

•Screen all women for sickle cell diseases and

thalassaemias (ideally by 10 weeks)•The type of screening depends upon the prevalence

and can be carried out in primary or secondary care

- high prevalence: laboratory screening

- low prevalence: initial screening with ‘Family Origins Questionnaire’

Screening for fetal anomalies

• Screen for Down’s syndrome using:

- the ‘combined test’ between 11 weeks 0 days and 13 weeks 6 days

- a serum screening test (triple or quadruple test) between 15 weeks 0 days and 20 weeks 0 days

• Participate in regional congenital anomaly registers and/or UK National Screening Committee-approved audit systems

Screening for clinical conditions

•At the booking appointment screen for risk

factors associated with gestational

diabetes

•Offer testing for gestational diabetes if any

one risk factor identified

Costs and savings per 100,000 population

Recommendations with significant resource impact (+/- )

Costs/savings (£ in first year)

Screening for fetal anomalies 12,700

Screening for Down’s syndrome 6,500

Screening and testing for gestational diabetes 2,900

Treatment of gestational diabetes 1,500

Avoidance of neonatal care for babies of women with diabetes – 2,300

Estimated net cost of implementation 21,300

This slide includes Diabetes in Pregnancy costs and savings

For discussion

What is our current advice regarding vitamin D supplementation? How can we reach the ‘at risk’ groups?

How can we ensure current referral patterns allow for early screening for haematological conditions? Who is best placed to offer this test?

What changes will we need to make to ensure that we are screening all women at booking for gestational diabetes?

NICE Pathway

The NICE antenatal care pathway covers all routine care for pregnant women and entry into other pathways for additional care

Click here to go to NICE Pathways

website

NHS Evidence

Visit NHS Evidence for the best available evidence on all aspects of maternity care

Click here to go to the NHS Evidence

website

Find out more

Visit www.nice.org.uk/guidance/CG62 for:

•the guideline •‘Understanding NICE guidance’•costing report and template/costing statement•audit support