Archive February 2008
ANTENATAL SCREENING

What we know
What information do we have about the Eastern Board area?
What is the result of this on our health locally?
Policies
What is happening in the Eastern Board area?

 

Statistics
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Links
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Documents
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What we know

Screening during pregnancy is aimed at assessing the risk that a fetus may have a particular genetic or congenital condition or that a pregnant woman has, or is at risk of having, a condition or complication of pregnancy that may affect the wellbeing of herself or her fetus. Once the risk is assessed, further diagnostic tests may be offered/carried out.

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What information do we have about the Eastern Board area?

The National Screening Committee (NSC) advises Government on screening policy and quality assurance. Currently the NSC supports screening during pregnancy for the following conditions:

Maternal Conditions

Anaemia
Hepatitis B
HIV
Syphilis
Pre-eclampsia
Rubella immunity



Fetal Conditions

Neural tube defect
Down’s Syndrome
Fetal anomalies
Haemoglobinopathies and Sickle Cell Disease
Haemolytic disease of the newborn
Tay Sachs Disease (for high risk populations)
Condition Frequency Impact of screening on health
Anaemia 1 in 10 pregnancies Intervention reduces likelihood of anaemia at term
Hepatitis B 1 in 300 pregnancies1 Intervention including neonatal vaccination substantially reduces the risk of infection in infant
HIV 1 in 3000 pregnancies1 Intervention substantially reduces the risk of infection in the infant
Syphilis 1 in 5000 pregnancies2 Intervention substantially reduces risk of congenital syphilis in the infant
Pre-eclampsia 1 in 10 to 1 in 50 pregnancies Reduces risk of morbidity and mortality for fetus and mother
Rubella immunity 1 in 100 pregnancies1 Vaccination offered to non-immune women reduces risk of congenital rubella syndrome in future pregnancies
Neural Tube Defect 1 in 1000 pregnancies Informed decisions regarding pregnancy
Down’s Syndrome 1-2 per 1000 pregnancies, increases with maternal age
(1 in 100 for women aged 40)		 Informed decisions regarding pregnancy
Fetal anomalies 1 in 50 births (includes minor anomalies) Informed decisions regarding pregnancy
Haemoglobinopathies & Sickle Cell Disease 1 in 2000 to10,000 pregnancies Informed decisions regarding pregnancy
Haemolytic disease of the newborn In 1 in 10 births the fetus is RhD positive and the mother RhD negative. Prior to screening 1% of all births were affected by haemolytic disease, with one death in every 2200 births Early diagnosis and prophylaxis/interventions has reduced the frequency of affected infants to 1 in 21,000 births. Implementation of routine antenatal anti-D prophylaxis in 2004 is expected to reduce further the associated morbidity and mortality
Tay Sachs Disease 1 in 3600 births among Ashkenazi Jewish populations Informed decision regarding pregnancy

1 Northern Ireland data
2 Eastern area data



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What is the result of this on our health locally?
For some conditions (e.g. anaemia, hepatitis B, HIV, syphilis, pre-eclampsia, haemolytic disease of the newborn), early diagnosis and appropriate treatment can improve the outcome for the fetus and/or mother. In other conditions screening allows parents to make informed decisions regarding the pregnancy.

Screening can never be 100% accurate, i.e. it cannot identify all cases. ‘Abnormal’ results may occur among pregnant women/pregnancies who do not have the condition being screened for (false positives). Thus screening may result in unnecessary anxiety and investigations, which may have adverse effects.


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Policies

In Northern Ireland the policy of the Department of Health, Social Services & Public Safety is for the following screening programmes to be offered to all pregnant women:

Anaemia
Hepatitis B
HIV
Syphilis
Pre-eclampsia
Rubella immunity
Haemolytic disease of the newborn

Screening for the following conditions is currently under review:

Neural tube defect
Down’s Syndrome
Fetal anomalies


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What is happening in the Eastern Board area?
Condition Practice in Eastern Area
Anaemia Part of routine antenatal care
Hepatitis B Offered to all women
HIV Offered to all women
Syphilis Offered to all women
Pre-eclampsia Part of routine antenatal care
Rubella immunity Offered to all women
Neural Tube Defect Offered to selected groups and on request
Down’s Syndrome Offered to selected groups and on request
Fetal anomalies Anomaly ultrasound scan offered to all women
Haemolytic disease of the newborn Maternal RhD status identified as part of routine antenatal care. Antenatal and post natal anti-D prophylaxis offered as appropriate


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For further information on this topic please contact us at publichealth@ehssb.n-i.nhs.uk

Eastern Health and Social Services Board Champion House, 12-22 Linenhall Street, Belfast BT2 8BS Telephone: (028) 9032 1313 Fax: (028) 9055 3681 Text Phone:(028) 9032 4980 Website: www.ehssb.org E-mail: pr@ehssb.n-i.nhs.uk
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