National Institute for Health and Clinical Excellence (NICE)
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Updated NICE guideline published on care and support that

The National Institute for Health and Clinical Excellence (NICE) and the National
Collaborating Centre for Women’s and Children’s Health have today (26 March 2008)
issued newly updated advice on the care that should be offered to women during
their pregnancy. This advice is an update of the original document published in 2003,
revising areas where new information has become available. It recommends that
midwives and doctors provide women with evidence-based information about a range
of key issues such as the risks and benefits of screening tests and lifestyle advice so
they can make decisions that are right for them and their baby.

The guideline includes recommendations for doctors and midwives on the advice
they should give to pregnant women about drinking alcohol. These recommendations
are consistent with the advice issued in 2007 by the UK Chief Medical Officers. The
NICE recommendations are that:

• Pregnant women and women planning to become pregnant should be advised to
avoid drinking alcohol in the first 3 months of pregnancy, because there may be
an increased risk of miscarriage.
• Women should be advised that if they choose to drink alcohol while they are
pregnant they should drink no more than 1-2 UK units once or twice a week
There is uncertainty about how much alcohol is safe to drink in pregnancy, but at
this low level there is no evidence of any harm to their unborn baby.
• Women should be advised not get to drunk or binge drink (drinking more than 7.5
UK units of alcohol on a single occasion) while they are pregnant because this
can harm their unborn baby.

Further recommendations from the guideline include:

• All women should be informed at the booking appointment about the importance
for their own and their baby’s health of maintaining adequate vitamin D stores
during pregnancy and whilst breast feeding. Women may choose to take 10
micrograms of vitamin D per day.

• Screening for sickle cell diseases and thalassaemias should be offered to all
women as early as possible in pregnancy (ideally by 10 weeks).

• The ‘combined test’ should be offered to screen for Down’s syndrome between 11
weeks 0 days and 13 weeks 6 days.

• Screening for gestational diabetes using risk factors is recommended in all
women. At the booking appointment, the following risk factors for gestational
diabetes should be determined: a) body mass index above 30 kg/m2 b) previous
macrosomic baby weighing 4.5 kg or above c) previous gestational diabetes d)
family history of diabetes e) family origin with a high prevalence of diabetes such
as south asian, black caribbean and middle eastern.

Professor Sir Liam Donaldson, Chief Medical Officer says: “I welcome this
updated NICE guidance as it further strengthens the advice from the UK CMO's that
pregnant women or women trying to conceive should avoid drinking alcohol. NICE's
guidance highlights this is most important at the beginning of pregnancy, when there
may be an increased risk of miscarriage, and again reinforces that if they do choose
to drink, to protect the baby, they should not drink more than 1 to 2 units of alcohol
once or twice a week and should not get drunk. Pregnant women or women trying to
conceive should seek further advice from their Midwives or GP.”

Dr Gillian Leng, Deputy Chief Executive, and Executive Lead for this guidance
says:
“We recommend that doctors and midwives should advise women to avoid
drinking alcohol when trying to get pregnant and during the first three months of
pregnancy because there may be an increased risk of miscarriage. If they do choose
to drink alcohol while pregnant, women should also be advised to drink no more than
1 to 2 UK units once or twice a week, and to avoid binge drinking during their
pregnancy because this can harm their unborn baby.

“Due to changes in the evidence base and new availability of screening programmes,
we have initiated this update earlier than planned. Having a baby is one of the most
important times in a woman’s life and healthcare professionals want to make sure
this is a good and safe experience. This newly updated guideline will ensure that
health professionals offer women the information and support they need to make
decisions about their care that are right for them and their babies.”

Dr Rhona Hughes, Lead Obstetrician and Guideline Development Group Chair
says:
“This guideline respects that it is a woman’s right to make her own decisions
about her pregnancy, based on the best available information. For example she may
accept or decline tests that are offered and her healthcare team will respect the
decision she makes. I recently met a family who had a baby with a learning disability
- unsurprisingly they were worried that their second baby could have a similar
problem but didn’t know whether to accept all the screening tests they were being
offered. Under the guideline, doctors would put this woman and her partner in touch
with support groups and provide written information so that they can come to an
informed decision about whether they want to go ahead and have screening tests.”

Nina Khazeaezadeh, Consultant Midwife, Supervisor of Midwives and Guideline Development Group member: “As a midwife in one of the busiest maternity units in the country, I know that this guideline will really benefit the midwives and doctors looking after women during pregnancy, as well as the women themselves. Women are already receiving good antenatal care but this guideline will bring it up to a gold standard and ensure that all women are receiving the same high quality care. For example, it will ensure that healthcare professionals provide women with consistent information about how many antenatal appointments they will receive and what will be discussed at each of these, such as advice on breastfeeding and nutrition. By giving women good information at the right stages in their pregnancy they will be best placed to make decisions that are right for them and their baby.”

Jennifer Elliott, Service User Representative and Guideline Development Group member says: “When I was pregnant with my first child I didn’t really understand why tests such as those for Down’s syndrome were being offered to me or even that they were being offered at all - as a result l did not feel in control of my pregnancy. This guideline firmly places women at the centre of decision making about their care – all women will be given information about why screening tests are carried out, what other decisions testing might lead to and be able to discuss their concerns and ask questions. By ensuring that women are informed about their pregnancy, they will feel less anxious and more likely to have a positive experience.”

Notes to Editors

1. The guidance is available at www.nice.org.uk/CG62.

2. One small glass of wine = 1.5 units

3. Five small glasses of wine = 7.5 units

About NICE

1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

public health – guidance on the promotion of good health and the prevention of ill
health for those working in the NHS, local authorities and the wider public and
voluntary sector
health technologies – guidance on the use of new and existing medicines,
treatments and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with
specific diseases and conditions within the NHS.