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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