Study questions necessity of some routine antenatal screening tests and calls for a uniform policy

The study found that 79% of respondents (hospitals and/or Divisions of General Practice) recommended pregnant women follow the 'standard' schedule of antenatal visits to the doctor - every four weeks until 28 weeks gestation, then every two weeks until 36 weeks, then every week until 40 weeks or delivery.

Study author, Dr Jenny Hunt, from the Centre for the Study of Mothers' and Children's Health at La Trobe University in Melbourne, questioned why Australia still follows this 'standard' when a World Health Organization systematic review has concluded that fewer routine antenatal visits are not associated with worse outcomes for mothers or babies.

"Approaches with fewer prescribed visits could offer women more flexibility in antenatal care, and may become a new standard," Dr Hunt said.

The study also questioned the need for certain antenatal screening such as gestational diabetes mellitus (GDM).

"Improved outcomes for women or babies attributed to screening for and managing GDM have not been clearly demonstrated. In addition, labelling women as 'high risk' during and after pregnancy, giving prescriptive advice about diet and exercise, and managing women with insulin may each have adverse effects," Dr Hunt said.

The study compared guidelines on antenatal screening for syphilis, HIV and Hepatitis C virus (HCV).

"There are currently no interventions that reduce the risk of transmission of HCV from mother to baby. A diagnosis of HCV can result in significant psychosocial morbidity…If nothing can be done to improve outcomes, during pregnancy may not be the best time for a woman to have an HCV test, nor to find out she is HCV positive," she said.

The study found that antenatal care guidelines varied markedly among institutions and recommended systematic reviews be conducted and Australian national guidelines be developed and disseminated to reduce inconsistencies.

"In Victoria, three tertiary maternity hospitals have combined resources to develop evidence-based consensus guidelines, aiming to standardise routine antenatal care in these institutions," Dr Hunt said.

An editorial in the same issue of the Medical Journal of Australia has called for the redefining of the purpose of antenatal care in Australia.

Head of the Department of Obstetrics and Gynaecology at Adelaide University, Professor Jeffrey Robinson, said that while aims may differ for consumers and caregivers, they should be incorporated into an 'ideal' model of care.

"Clinical practice guidelines should define best practice, limit variations in the provision of care, recommend care that is cost-effective, and provide care in a way that meets the needs of all patients.

"The principles of antenatal care were adopted over half a century ago; their maintenance can only be supported when rigorously tested against the best currently available evidence, which can then be incorporated into national guidelines for best practice,"

Professor Robinson said.

The Medical Journal of Australia is a publication of the Australian Medical Association.