Prenatal care or care during pregnancy is necessary
to ensure a healthy mother and a healthy baby. The U.S. Preventive Services
Task Force (USPSTF) has recommended that some tests should be included as a
part of routine prenatal care. It has suggested recommendations for tests like
urine culture, anemia screening, oral glucose tolerance test and urinalysis
is used to diagnose the presence of bacteria in the urine. A urine
infection can lead to low birth weight babies. As per the guidelines, this screening test should be done once early in
is detected through blood
tests that measure hemoglobin levels and hematocrit. Anemia in pregnancy
increases the risk for low birth weight, preterm delivery, and death of the
baby during delivery. The guidelines
also suggest doing this test during pregnancy
in pregnancy may lead to
complications like big babies, low blood sugar in the baby post delivery,
premature delivery, birth injury, intensive neonatal care admission, and
jaundice in the newborn. It can also predispose the mother to preeclampsia. Diabetes in pregnancy is diagnosed using
oral glucose tolerance test, though the evidence of any benefit for doing the
test is considered insufficient by the USPSTF.
is a test where the urine is
tested for infection, presence of protein or glucose in the urine. This test is
not recommended for routine purpose by the USPSTF.
A study was
conducted to evaluate the use of these tests in pregnant women in the United
States and whether they were as per the recommendations of the USPSTF
. Data collected included
race, age, region, payer type and pregnancy status in terms of being high or
Most of the women included in the study were White,
in their 20s, paid for their visit using private insurance and were in the
During the years 2003 and 2004, urine cultures were
done at an average of 0.4 cultures per pregnancy. Thus, a urine culture was done in less than half the pregnancies
This is much lower than recommended.
Screening for anemia was carried out at an average
of 1.4 screenings per pregnancy between the years 2001 and 2003. The average
reduced to 1.1 screenings per pregnancy between the years 2004 and 2006. Thus,
anemia screening appears to be adequate as per the recommendations.
There was nearly 1 oral GTT per pregnancy conducted
between 2003 and 2006, though the guidelines suggest there is insufficient
evidence to suggest or disapprove the testing.
Urinalysis was done at an average of 5.6 per
pregnancy between 2001 and 2003. Between 2004 and 2006, the average reduced to
4.3 per pregnancy. The number of
urinalysis done was far more than recommended
. However, the number has been
declining over the last few years.
The study also found that women from minority
communities like Hispanics and Blacks and women between the ages of 30 and 34
years are more often tested for urine cultures, anemia screenings, and oral
glucose tolerance tests than white women and younger women.
Thus, what is
followed in practice appears to be quite different from what is actually
recommended. A better adherence to the recommended guidelines could go a long
way in improving prenatal care. Reference
1. Screening Tests During Prenatal Care; Juned Siddique et al; Maternal
and Child Health Journal 2012.