Key priorities for implementation

Antenatal information

• Pregnant women should be offered information based on the current available evidence together with support to enable them to make informed decisions about their care. This information should include where they will be seen and who will undertake their care

Lifestyle considerations

• All women should be informed at the booking appointment about the importance for their own and their baby’s health of maintaining adequate vitamin D stores during pregnancy and whilst breastfeeding. In order to achieve this, women may choose to take 10 micrograms of vitamin D per day, as found in the Healthy Start multivitamin supplement. Particular care should be taken to enquire as to whether women at greatest risk are following advice to take this daily supplement. These include:
  • women of South Asian, African, Caribbean or Middle Eastern family origin
  • women who have limited exposure to sunlight, such as women who are predominantly housebound, or usually remain covered when outdoors
  • women who eat a diet particularly low in vitamin D, such as women who consume no oily fish, eggs, meat, vitamin D-fortified margarine or breakfast cereal
  • women with a pre-pregnancy body mass index above 30 kg/m2

Screening for haematological conditions

• Screening for sickle cell diseases and thalassaemias should be offered to all women as early as possible in pregnancy (ideally by 10 weeks). The type of screening depends upon the prevalence and can be carried out in either primary or secondary care

Screening for fetal anomalies

• Participation in regional congenital anomaly registers and/or UK National Screening Committee-approved audit systems is strongly recommended to facilitate the audit of detection rates
• The ‘combined test’ (nuchal translucency, beta-human chorionic gonadotrophin, pregnancy-associated plasma protein-A) should be offered to screen for Down’s syndrome between 11 weeks 0 days and 13 weeks 6 days. For women who book later in pregnancy the most clinically and cost-effective serum screening test (triple or quadruple test) should be offered between 15 weeks 0 days and 20 weeks 0 days

Screening for clinical conditions

• Screening for gestational diabetes using risk factors is recommended in a healthy population. At the booking appointment, the following risk factors for gestational diabetes should be determined:
  • body mass index above 30 kg/m2
  • previous macrosomic baby weighing 4.5 kg or above
  • previous gestational diabetes (refer to Diabetes in pregnancy [NICE clinical guideline 63], available from www.nice.org.uk/CG063)
  • family history of diabetes (first-degree relative with diabetes)
  • family origin with a high prevalence of diabetes:
• South Asian (specifically women whose country of family origin is India, Pakistan or Bangladesh) black Caribbean
• Middle Eastern (specifically women whose country of family origin is Saudi Arabia, United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait, Lebanon or Egypt)
• Women with any one of these risk factors should be offered testing for gestational diabetes (refer to Diabetes in pregnancy [NICE clinical guideline 63], available from www.nice.org.uk/CG063)