Antenatal care: timetable

Question 1

Antenatal care: timetable

Answer 1

Antenatal Screening

The National Screening Committee (NSC) suggest the following policy regarding antenatal screen

Question 2

Antenatal care: specific points

NICE issued guidelines on routine care for the healthy pregnant woman in March 2008

Nausea and vomiting
natural remedies - ginger and acupuncture on the ‘p6’ point (by the wrist) are recommended by NICE
antihistamines should be used first-line (BNF suggests promethazine as first-line)

Answer 2

Vitamin D

• NICE recommend ‘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’
• women may choose to take 10 micrograms of vitamin D per day, as found in the Healthy Start multivitamin supplement’. This was confirmed in 2012 when the Chief Medical Officer advised: ‘All pregnant and breastfeeding women should take a daily supplement containing 10micrograms of vitamin D, to ensure the mothers requirements for vitamin D are met and to build adequate fetal stores for early infancy’’
• particular care should be taken with women at risk (e.g. Asian, obese, poor diet)

Question 3

Antenatal care: lifestyle advice

Nutritional supplements

Answer 3

• folic acid 400mcg should be given from before conception until 12 weeks to reduce the risk of neural tube defects. Certain women may require higher doses (women who take antiepileptics)
• iron supplementation should not be offered routinely
• vitamin A supplementation (intake above 700 micrograms) might be tetragenic. Liver is high in vitamin A so consumption should be avoided
• vitamin D: ‘women should be advised to take a vitamin D supplement (10 micrograms of vitamin D per day), as found in the Healthy Start multivitamin supplement. Women who are not eligible for the Healthy Start benefit should be advised where they can buy the supplement’. Particular care should be taken with higher risk women (i.e. those with darker skin or who cover their skin for cultural reasons)

Question 4

Antenatal care: lifestyle advice

Alcohol

Answer 4

the government now recommend pregnant women should not drink. The wording of the official advice is ‘If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.’

Question 5

Antenatal care: lifestyle advice

Smoking

Answer 5

• risks of smoking including low birthweight and preterm birth should be discussed
• NRT may be used but woman must of stopped smoking and risks/benefits need to be discussed
• neither varenicline or bupropion should be offered to pregnant or breastfeeding women

Question 6

Antenatal care: lifestyle advice

Food acquired infections

Answer 6

• listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
• salmonella: avoid raw or partially cooked eggs and meat, especially poultry

Question 7

Down’s syndrome: antenatal testing

NICE issued guidelines on antenatal care in March 2008 including advice on screening for Down’s syndrome

Answer 7

• the combined test is now standard: nuchal translucency measurement + serum B-HCG + pregnancy associated plasma protein A
• these tests should be done between 11 - 13+6 weeks
• if women book later in pregnancy either the triple* or quadruple test** should be offered between 15 - 20 weeks

*alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin

**alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin-A