Identifying sociomedical risk factors during pregnancy: recommendations from international evidence-based guidelines

Abstract

Sociomedical risks are common problems during pregnancy and can have serious health consequences for both mother and child. They are frequently underestimated within prenatal care programmes, although routine screening could help identify women in need of additional support. The aim of this article was to systematically summarise risk assessment and screening recommendations for mental health problems, depression, substance misuse and intimate partner violence during pregnancy using evidence-based guidelines, in order to provide a decision support for healthcare professionals and policy-makers. A systematic literature search in two guideline databases was carried out and websites of international institutions developing evidence-based guidelines were searched. Guidelines from Western, industrialised countries, published in English or German since 2007 and providing recommendations for sociomedical screenings during pregnancy were included. Furthermore, guidelines had to be based on a systematic literature search in at least two databases and had to involve recommendations explicitly linked to the evidence. Sixteen guidelines, developed by nine institutions from Europe, the United States, Canada and Australia, met the inclusion criteria. The majority of the guidelines recommended routine assessment, although some conflicting recommendations were found for depression, illicit drug use and violence. Our research findings suggest that screening or assessment for the analysed risk factors is advisable. However, the assigned grades of recommendation reflect that the evidence base is limited. Further research should also concentrate on evaluating different screening methods, as there was little consensus on the ideal screening test.