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Consider the following areas:

• Fetal Anomaly
• Intra uterine growth restriction
• Pre eclampsia
• Premature delivery

Intervention that have been shown to prevent antenatal conditions

Problem	Intervention	Appropriate group	Reference
Fetal anomaly (neural tube defects)	Preconceptual folic acid 400mg until 12 weeks gestation	All women Those at high risk (previous neural tube defect, epileptic,diabetic) 5mg.	1
Preterm birth	Treatment of bacterial vaginosis(BV) Cervical cerclage Treatment of asymptomatic bacteriuria	Previous preterm delivery and BV in that pregnancy Previous preterm deliveries secondary to cervical incompetence All women	2 3 4
Pre eclampsia	Low dose aspirin Vitamin C and E Calcium	Small/moderate reduction – possibly more so in high risk women High risk women High risk, low background calcium intake	5 6 7
IUGR	Smoking cessation Malaria prophylaxis Balanced protein calorie nutrition	Smokers- best benefit <16 weeks Primips in areas of high malaria prevalence Severely malnourished	8, 9 10 11

Although not a comprehensive list of antenatal complications, this demonstrates that many currently available interventions are applicable only to select groups of pregnant women. For the majority of the population, care focuses on the detection of certain conditions. However, even this has its limitations. For example, pre eclampsia is routinely screened for with urinalysis and blood pressure measurement. What has not been agreed is the optimal interval between measurements. In addition, 10% of those women who suffer an eclamptic fit do so without prior rise in blood pressure or proteinuria.

Intrauterine growth restriction is usually screened for using symphysial fundal height (SFH) measurement. However, in a recent Cochrane review there was only one trial of sufficient quality to be included in the analysis (12). This did not confer benefit but was considered of insufficient power to do so. More promising results have been obtained from a trial using customised SFH charts, where detection was 48% (control group 29%) despite a reduction in referral for antenatal ultrasound scans (13).

The preterm prevention study group have published extensively on the subject of premature delivery and a combination of biochemical and mechanical factors (such as cervical length) show promise to detect preterm delivery in high risk women (14). The same has not been shown to date in low risk women (15).

References

1.Lumly J, Watson L, Watson M, Bower C. Periconceptual supplements with folate and/or multivitamins for preventing neural tube defects. The Cochrane Library. Oxford: Update Software: 2000: 1-13.

2. Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo controlled, double blind study. American Journal of Obstetrics and Gynaecology 1994; 171:345-347, Abstract

3.MRC/RCOG working party on cervical cerclage. Final report of the Medical Research Council/Royal college of Obstetricians and Gynaecologists multi-centre randomised trial of cervical cerclage. British Journal of Obstetrics and Gynaecology 1993; 100: 526-23, Abstract

4.Smaill F. Antibiotic vs no treatment for asymptomatic bacteriuria. In: Pregnancy and Childbirth Module (eds Enkin MW, Keirse MJNC, Renfrew MJ,Neilson JP), “CochraneDatabase of Systematic Reviews”: Review No.03170,22 April 1993. Published through “Cochrane Updates on Disk”, Oxford: Update Software, 1993,Disk Issue 2.

5.Duley L, Henderson-Smart D, Knight M, King J. Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review, Abstract

6.Chappell LC, Seed PT, Briley AL, Kelly FJ, Lee R, Hunt BJ et al. Effect of antioxidants on the occurrence of pre-eclapmsia in women at increased risk: a randomised trial. Lancet 1999; 354: 810-16, Abstract

7. Atullah AN, Hofmeyr JG, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. The Cochrane Library, Issue 1. Oxford: Update Software;2000, Abstract

8. Hjalmarson A, Hahn J, Svanberg B. Stopping smoking in pregnancy ; effect if a self help manual in a controlled trial. British Journal of Obstetrics and Gynaecology 1991; 98: 859-65, Abstract

9. Hadow JE, Knight GJ, Kloza EM, Palomaki GE, Wald NJ. Cotine assisted intervention in pregnancy to reduce smoking and low birth weight delivery. British Journal of Obstetrics and Gynaecology 1991; 98: 260-4, Abstract

10. Garner P, Brabin B. A review of randomised controlled trials of routine antimalaria drug prophylaxis during pregnancy in endemic malaria areas. WHO Bulletin 1994; 72: 89-99.

11. Kramer M. Effect of energy and protein intakes on pregnancy outcome: an overview of the research evidence in controlled clinical trials. American Journal of Clinical Nutrition 1993; 58: 627-35,

12. Neilson JP. Symphysis-fundal height measurement in pregnancy (Cochrane Review). In: The Cochrane Library, Issue 4, 2001. Oxford: Update Software, Abstract

13. Gardosi J, Francis A. Controlled trial of fundal height measurement plotted on customised antenatal growth charts. British Journal of Obstetrics and Gynaecology. 199; 106(4): 309-17, Abstract

14. Goldenberg R L, Iams J D et al The Preterm Prediction Study: toward a multiple-markerfor spontaneous preterm birth. Am J Obstet Gynecol 2001; 185(3): 643-51, Abstract

15. Iams J D, Goldenberg R L et al. The Preterm Prediction Study: can low-risk women destined for spontaneous preterm birth be identified? Am J Obstet Gynecol 2001; 184(4): 652-5, Abstract