Antenatal Clinics and Specialist Care: Consultations, Referrals, Treatment Guidelines - 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 Anti-D Administration in Pregnancy for Preventing Rhesus Alloimmunisation.
- 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 Diet and/or Exercise for Pregnant Women for Preventing Gestational Diabetes Mellitus.
- Balanced energy/protein supplementation may improve fetal growth and may reduce the risk of fetal death in general obstetric population Energy and Protein Intake in Pregnancy.
- Women with gestational diabetes mellitus appear to be in increased risk for pre-eclampsia, caesarean section, and macrosomic and large for gestational age babies Gestational Diabetes Mellitus and Pregnancy Outcomes.
- 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 Different Intensities of Glycaemic Control for Pregnant Women with Pre-Existing Diabetes.
- 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 insufficientDifferent Types of Dietary Advice for Women with Gestational Diabetes Mellitus.
- There is insufficient evidence about interventions for reducing excessive weight gain in pregnancy. However, behavioural counselling might possibly be effective compared with standard care Interventions for Preventing Excessive Weight Gain during Pregnancy.
- There is insufficient evidence to determine whether symphysis fundal height (SFH) measurement is effective in detecting fetal intrauterine growth restriction Symphysial Fundal Height (Sfh) Measurement in Pregnancy for Detecting Abnormal Fetal Growth.
- 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 Cervical Stitch (Cerclage) for Preventing Preterm Birth in Singleton Pregnancy.
- 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 Home Uterine Activity Monitoring for Detection of Preterm Labour.
- Treatment of women with normal thyroid function but positive peroxidase antibodies might possibly reduce preterm birth, but the evidence in insufficient Subclinical Hypothyroidism and 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 Antithrombotic Therapy for Women Considered at Risk of Placental Dysfunction.
- Caesarean section may not be benenficial compared to vaginal delivery for the prevention of anal incontinence in average risk women Cesarean Delivery for the Prevention of Anal Incontinence.
- There is insufficient evidence of antenatal psychosocial assessment for reducing perinatal mental health outcomes .
- There is insufficient evidence and inconclusive results of home visits in the early postpartum period Schedules for Home Visits in the Early Postpartum Period.
- There is insufficient evidence on the effect of telephone support for women during pregnancy and postpartum Telephone Support for Women during Pregnancy and the First Six Weeks Postpartum.
- Routine cervical assessment by ultrasound may not be effective for preventing preterm delivery Cervical Assessment by Ultrasound for Preventing Preterm Delivery.
- Low glycaemic index diet seems to beneficial for preventing gestational diabetes mellitus compared to high glycaemic index diet, although the evidence is limited Dietary Advice in Pregnancy for Preventing Gestational Diabetes Mellitus.
- Small amounts of caffeine seem not to affect pregnancy outcomes like birthweight or preterm birth, although the evidence is insufficient Effects of Restricted Caffeine Intake by Mother on Pregnancy Outcome.
- Intramuscular and intravenous administration of anti-D Immunoglobulin may be equally effective for preventing Rhesus alloimmunization during pregnancy Intramuscular Versus Intravenous Anti-D for Preventing Rhesus Alloimmunization during Pregnancy.
- There is insufficient evidence to determine the efficacy and safety of nicotine replacement therapy for smoking cessation in pregnancy Pharmacological Interventions for Promoting Smoking Cessation during Pregnancy.
- There is insufficient evidence of psychological and educational interventions for reducing alcohol consumption in pregnant women Psychological and/or Educational Interventions for Alcohol or Drug Consumption in Pregnancy.
- 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 Psychosocial Interventions for Pregnant Women in Outpatient Illicit Drug Treatment Programs Compared to other Interventions.
- 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 Maintenance Agonist Treatments for Opiate Dependent Pregnant Women.
- 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 Effect of N-3 Long-Chain Polyunsaturated Fatty Acid Supplementation of Women with Low-Risk Pregnancies on Pregnancy Outcomes and Growth Measures at Birth.
- 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 Intermittent Oral Iron Supplementation during Pregnancy.
- Topical preparations appear not to be effective in the prevention of stretch marks during pregnancy compared to placebo Topical Preparations for Preventing Stretch Marks in Pregnancy.
- Antibiotics are effective in the treatment of bacterial vaginosis in pregnancy but do not prevent preterm birth before 37 weeksAntibiotics for Treating Bacterial Vaginosis in Pregnancy.
- There is insufficient evidence of the effect of prenatal education for preventing congenital toxoplasmosis Prenatal Education for Congenital Toxoplasmosis.
- Plasma estriol estimation in high-risk pregnancies seems to be of no benefit but there is no evidence from good quality studies Biochemical Placental Function Tests for Foetal Assessment.
- There is insufficient evidence on which to base recommendations for thromboprophylaxis during pregnancy and the early postnatal period .
- Offering specific treatment for gestational diabetes (GDM) may be associated with better baby and mother outcomes, but there is lack of evidence on the best mode of treatment for GDM and on long-term mother and baby outcomes Treatments for Gestational Diabetes.
- Advice to reduce salt intake in pregnancy appears not to prevent pre-eclampsia Altered Dietary Salt for Preventing 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 Antioxidants for Preventing Pre-Eclampsia.
- A prebiotic supplement added to infant feeds might possibly prevent eczema, although the data are limited Prebiotics in Infants for Prevention of Allergic Disease and Food Hypersensitivity.
- Multiple-micronutrient supplementation during pregnancy in low or middle-income countries appears to decrease the number of low birthweight babies Multiple-Micronutrient Supplementation (Mms) during Pregnancy.
- 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 Prenatal Administration of Progesterone for Preventing Preterm Birth .
- Magnesium sulphate is ineffective at delaying birth or preventing preterm birth Magnesium Sulphate for Preterm Labour.
- Magnesium sulphate (Mg) is more effective than diazepam, phenytoin or lytic cocktail in the treatment of eclampsia Magnesium Sulphate for Eclampsia and Pre-Eclampsia.
- Ursodeoxycholic acid (UDCA) may slightly improve pruritus for cholestasis in pregnancy compared with placeboInterventions for Treating Cholestasis in Pregnancy.
- Endoscopic laser coagulation of anastomotic vessels appears to improve perinatal and neonatal outcomes compared with amnioreduction in twin-twin transfusion syndrome Interventions for the Treatment of Twin-Twin Transfusion Syndrome.
Other evidence summaries
- Exposure to organic solvents during pregnancy may increase the risk for fetal malformations .
- If patient leaflets are introduced in maternity care, approval and support for their use need to be secured from all health care workers, the personnel should be well familiarized with the leaflets and preferably the leaflets should be integrated to the system .
- Acupressure at the Neiguan P6 point may have some effect in treating nausea and vomiting in early pregnancy Acupressure and Acupuncture for Treating Nausea and Vomiting in Early Pregnancy.
- The benefit from home uterine activity monitoring in improving morbidity and mortality remains unclear Home Uterine Activity Monitoring for Detection of Preterm Labour.
- The diagnostic efficiency of home pregnancy kits may be variable and greatly affected by the characteristics of the users .
- Noninvasive foetal DNA determination of Rh genotype based on maternal peripheral blood may be highly accurate, especially in the first trimester .
Literature
- Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA. Liver disease in pregnancy. Lancet 2010 Feb 13;375(9714):594-605. [PubMed]
- von Kaisenberg CS, Jonat W. Fetal parvovirus B19 infection. Ultrasound Obstet Gynecol 2001 Sep;18(3):280-8. [PubMed]
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