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Vitamin D supplementation in pregnancy

All pregnant women should receive supplement of vitamin D – 10 micrograms per day.

Women at greatest risk of vitamin D deficiency :-

  • women with darker skin (such as those of African, African – Caribbean or South – Asian family origin).
  • Women with limited exposure to sunlight (housebound or who cover their skin for cultural reasons).

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Screening for haematological conditions

Screening for sickle cell disease and thalassaemias – offered to ALL women  as early as possible in pregnancy, ideally by 10 weeks.

Screening for anomalies

Between 11 weeks 0 days and 13 weeks 6 days –  Combined test – Nuchal translucency, beta-hCG, PAPP-A.

Between 15 weeks 0 days and 20 weeks 0 days (for women who book later in pregnancy) – Triple or Quadruple test.

Screening for Gestational Diabetes Mellitus

Risk factors for Gestational DM :-

  • BMI > 30 kg/m².
  • Previous macrosomic baby weighing 4.5 kg or above
  • Previous gestational diabetes
  • 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, UAE, Iraq, Jordam Syria, Oman, Qatar, Kuwait, Lebanon or Egypt).

Women with any one of these risk factors should be offered testing for gestational diabetes with a 75 – g 2-hour OGTT at 24 – 28 weeks.

For women who have had gestational diabetes in a previous pregnancy, offer :

  • early self – monitoring of blood glucose or
  • a 75 – g 2 – hour OGTT as soon as possible after booking (whether in the first or second trimester), and a further 75 – g 2 – hour OGTT at 24 to 28 weeks if the results of the first OGTT are normal.

Frequency of antenatal appointments

Nulliparous women with uncomplicated pregnancy – 10 appointments should be adequate.

Parous with an uncomplicated pregnancy – 7 appointments should be adequate.

Gestational age assessment

Early ultrasound scan – between 10 weeks 0 days and 13 weeks 6 days – to determine gestational age and to detect multiple pregnancies.

Crown – rump length – to determine gestational age.  If the CRL is above 84 mm, the gestational age should be estimated using head circumference.

Working during pregnancy

For majority of women it is safe to continue working during pregnancy.

A woman’s occupation during pregnancy should be ascertained to identify those at higher risk of occupational exposure.

Nutritional supplements

Dietary supplementation with folic acid, before conception and throughout the first 12 weeks, reduces the risk of having a baby with a neural tube defect (for example, anencephaly or spina bifida).

Recommended dose of folic acid is 400 micrograms per day.

Iron supplementation should NOT be offered routinely to all pregnant women.  It does NOT benefit the mother’s or the baby’s health and may have unpleasant maternal side effects.

Vitamin A supplementation (above 700 micrograms) might be teratogenic and should be avoided.

Liver and liver products contain high levels of vitamin A, and therefore consumption of these products should also be avoided.

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Food - acquired infections

To reduce the risk of listeriosis in pregnancy, it is advised to :-

  • drink only pasteurised or UHT milk.
  • NOT eat ripened soft cheese such as Camembert, Brie and blue – veined cheese (there is NO risk with hard cheeses, such as Cheddar, or cottage cheese and processed cheese)
  • NOT eating pate (of any sort, including vegetable).
  • NOT eating uncooked or undercooked ready – prepared meals.

To reduce the risk of salmonella infection, pregnant women should be advised to :-

  • Avoid raw or partially cooked eggs or food that may contain them (such as mayonnaise).
  • Avoiding raw or partially cooked meat, especially poultry.

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