Antenatal clinics: care and examinations – Related resources

Cochrane reviews

• Administration of 100 µg (500 IU) anti-D immunoglobulinto women in their first pregnancy may reduce the risk of Rhesus D alloimmunisation during or immediately after a first pregnancy .
• Heparin therapy appears to be effective for decreasing the risk of perinatal mortality, preterm birth before 34 and 37 weeks' gestation, and infant birthweight below the 10th centile for gestational age when compared with no treatment in women considered at risk of placental dysfunction. However, important information about serious adverse infant and long-term childhood outcomes is unavailable .
• Treatment of women with normal thyroid function but positive peroxidase antibodies might possibly reduce preterm birth, but the evidence in insufficient .
• Balanced energy/protein supplementation may improve fetal growth and may reduce the risk of fetal death in general obstetric population .
• Providing dietary advice and blood glucose level monitoring for women with pregnancy hyperglycaemia not meeting GDM diagnostic criteria appear to be effective for reducing the number of macrosomic and large-for-gestational age babies .
• Exercise in pregnancy might possibly not be effective for preventing gestational diabetes, but the evidence is insufficient .
• Women with gestational diabetes mellitus appear to be in increased risk for pre-eclampsia, caesarean section, and macrosomic and large for gestational age babies .
• During pregnancy, loose glycaemic control (fasting blood glucose 6.7 to 8.9 mmol/L) might possibly increase pre-eclampsia, caesarean sections, and macrosomia compared with tight-moderate glycaemic control (fasting blood glucose under or 6.7 mmol/L) in women with type 1 diabetes, although the data are insufficient .
• One type of dietary advice might possibly not be more effective than another type of advice for women with gestational diabetes mellitus on pregnancy outcomes but the evidence is insufficient .
There is insufficient evidence about interventions for reducing excessive weight gain in pregnancy. However, behavioural counselling might possibly be effective compared with standard care .
• Intramuscular and intravenous administration of anti-D Immunoglobulin may be equally effective for preventing Rhesus alloimmunization during pregnancy .
• Cervical cerclage appears to reduce the incidence of preterm birth compared with no treatment in women at risk of recurrent preterm birth, without statistically significant reduction in perinatal mortality or neonatal morbidity .
• Caesarean section may not be benenficial compared to vaginal delivery for the prevention of anal incontinence in average risk women .
Intermittent iron plus folic acid regimens may possibly produce similar maternal and infant outcomes at birth as daily supplementation in pregnant women without anaemia, but are associated with fewer side effects .
• A prebiotic supplement added to infant feeds might possibly prevent eczema, although the data are limited .
There is insufficient evidence of vitamin D supplementation for women during pregnancy compared with no treatment .
• Multiple-micronutrient supplementation during pregnancy in low or middle-income countries appears to decrease the number of low birthweight babies .
• In women at increased risk of preterm birth, progesterone may reduce the risk of perinatal mortality, preterm birth less than 37 weeks' gestation, and infant birthweight less than 2500 grams compared to placebo. However, there is no evidence on long-term maternal and infant health outcomes, and potential harms raise concern .
• Calcium supplementation appears not to be effective for preventing preterm birth .
• Magnesium sulphate is ineffective at delaying birth or preventing preterm birth .
• Antenatal magnesium sulphate therapy for women at risk of preterm birth appears to reduce the risk of cerebral palsy in their child.
• Small amounts of caffeine seem not to affect pregnancy outcomes like birthweight or preterm birth, although the evidence is insufficient .
• There is insufficient evidence and inconclusive results of home visits in the early postpartum period .
• There is insufficient evidence on the effect of telephone support for women during pregnancy and postpartum .
• There is insufficient evidence of psychological and educational interventions for reducing alcohol consumption in pregnant women .
• Topical corticosteroids seem not to be harmful in pregnancy, although the evidence is insufficient .
• Midwife-led (licensed) care for pregnant women may be more effective than other models of care for pregnant women at low or mixed risk .
• There is insufficient evidence of antenatal psychosocial assessment for reducing perinatal mental health outcomes .
• Infection screening and treatment programs in pregnant women may reduce preterm birth and preterm low birthweights, but it is unclear to which component of the screening program the effect can be attributed .
• Home uterine activity monitoring appears not to be effective in improving infant morbidity and mortality compared with conventional care in women at high risk of preterm birth .
• There is insufficient evidence to determine whether symphysis fundal height (SFH) measurement is effective in detecting fetal intrauterine growth restriction .
• Use of biophysical profile in high-risk pregnancies may not reduce perinatal deaths or low Apgar scores.
• Assuming the hands and knees posture in late pregnancy to correct occipito-posterior position of the fetus may not improve pregnancy outcomes but using in labour may be beneficial in reducing back pain .
• Daily rest seems to have no effect for the risk of pre-eclampsia for women with normal blood pressure, although there is limited evidence from controlled trials .
• Advice to reduce salt intake in pregnancy appears not to prevent pre-eclampsia .
• Supplementation with vitamin C and vitamin E compared to placebo does not prevent pre-eclampsia in women at risk, and does not reduce the risk of intrauterine growth restriction, or the risk of death in the infants .
• Routine supplementation with vitamin B6 during pregnancy may not provide any beneficial effects on pregnancy outcomes .
• N-3 long-chain polyunsaturated fatty acid supplementation in low-risk pregnancy appears to be associated with a small increase in the duration of pregnancy compared to placebo or no supplementation .
• Ursodeoxycholic acid (UDCA) may slightly improve pruritus for cholestasis in pregnancy compared with placebo.
• Routine hospitalization for bed rest appears not to be effective in multiple pregnancy .
• Pregnant-specific exercise programs, physiotherapy and acupuncture added to usual prenatal care may reduce back or pelvic pain more than usual prenatal care .
• Group antenatal care might possibly be as safe as standard one-to-one care .
• Group antenatal education in promoting vaginal birth after caesarean section is probably not effective .
• There is no evidence either supporting or refuting the use of bed rest at home or in hospital to prevent preterm birth in singleton pregnancies .
• Evidence is insufficient for any intervention to treat varicose veins and leg oedema in pregnancy .
• There is insufficient evidence to determine the efficacy and safety of nicotine replacement therapy for smoking cessation in pregnancy ..There is insufficient evidence of the effect of home-based support for disadvantaged teenage mothers ."?>
• There is insufficient evidence of the effectiveness of psychosocial interventions on illicit drug use in pregnant women or obstetrical or neonatal outcomes. Contingency management strategies seem to improve retention in treatment programs .."?>
• Methadone, buprenorphine and oral slow morphine seem to have similar effect for opiate dependence in pregnant women for mother and child outcomes, although the evidence is limited .
• Antenatal antiviral prophylaxis appears to reduce viral shedding and recurrences at delivery and the need for caesarean section for genital herpes. There is insufficient evidence to determine if antiviral prophylaxis reduces the incidence of neonatal herpes, although the risk for neonatal infection seems to be low .
• Topical preparations appear not to be effective in the prevention of stretch marks during pregnancy compared to placebo .
• Intrapartum antibiotic prophylaxis for known maternal group B streptococcal colonization appears to reduce early onset group B streptococcus disease in the newborn .
There is insufficient evidence of the effect of prenatal education for preventing congenital toxoplasmosis .
• There are limited data and insufficient evidence about the effects of general advice and education in the pre-pregnancy period on outcomes for mothers and babies .
• There is no evidence that in women with iron-deficiency anaemia in pregnancy, improvement in women's haematological indices translate into clinical improvements for them or their children. However, treatments are associated with frequent adverse effects such as gastrointestinal disturbances and poor compliance..Routine folate supplementation during pregnancy improves haemoglobin levels and folate status, but there is no evidence of any effect on pregnancy outcomes .Routine oral iron supplementation with or without folic acid during pregnancy appears to increase haemoglobin levels, but seems to have no effect on clinical maternal and infant outcomes, although there is very limited evidence from controlled trials for these outcomes .
• Acupuncture, acupressure or acustimulation may not be effective in treating nausea and vomiting in early pregnancy .
• Mind-body interventions (imagery) might be effective for the management of anxiety during pregnancy .

Other evidence summaries

• Noninvasive foetal DNA determination of Rh genotype based on maternal peripheral blood may be highly accurate, especially in the first trimester .

Clinical guidelines

• Antenatal care: Routine care for the healthy pregnant woman

Literature

Clinical practice reviews

• Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 2010 Oct 14;363(16):1544-50.
• Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA 2005 Dec 7;294(21):2751-7.