Routine screening during prenatal care: a systematic comparison of the do not do recommendations of the National Institute for Health and Care Excellence with North American evidence-based guidelines

Abstract

BackgroundPopulation-wide screening measures during pregnancy might cause more harm than good in terms of health benefits. Therefore, the National Institute for Health and Care Excellence (NICE) formulated 14 do not do recommendations relating to 18 screening measures during pregnancy in the antenatal care guideline published in 2008. We aimed to compare do not do recommendations with evidence-based guidelines from developed countries other than the UK. MethodsWe systematically searched for corresponding recommendations in the guideline databases Guidelines International Network and National Guideline Clearinghouse applying a broad search strategy by using the keyword “screening”. Additionally, we searched websites of guideline development groups using disease-specific keywords. We included evidence-based guidelines published in English from Jan 1, 2007, to Dec 31, 2012, that dealt with routine screening during pregnancy. Guidelines had to fulfil predefined methodological quality criteria (ie, they needed to be based on a systematic literature search in at least two databases and needed to formulate recommendations explicitly linked to the underlying evidence). FindingsWe identified 13 relevant clinical practice guidelines from the USA and Canada covering 13 out of 18 do not do recommendations. The systematic guideline comparison showed that for seven screening measures recommendations were consistent. Differences across countries were observed for six screening measures: two of these screening measures not routinely recommended by NICE are explicitly recommended by North American clinical practice guidelines (chlamydia and streptococcus group B). Four of the six screening recommendations differed in terms of screening methods or the timing. For the remaining five of the 18 screening measures, we did not identify recommendations from the USA or Canada. InterpretationSeven of 18 prenatal screening recommendations from North American guidelines are in line with NICE do not do recommendations. The differences in six screening recommendations might be explained by specific contextual factors related to national health-care systems such as organisational aspects or disease prevalence. The comparison of international evidence-based guidelines can facilitate the re-evaluation of national public health programmes and can be a starting point for the appraisal of interventions in the national context. FundingThe Ludwig Boltzmann Institute for Health Technology Assessment is funded by national research funds (The Ludwig Boltzmann Gesellschaft) and by partner institutions (eg, the Federation of Austrian Social Insurance Institutions and the Austrian Ministry of Health). This in-depth comparison of screening recommendations was carried out within a larger project aiming at the reorientation of the Austrian parent-child preventive care programme on behalf of the Austrian Ministry of Health.