Antenatal and newborn screening

Antenatal and newborn screening 

Introduction

Antenatal and newborn screening programmes are an important element of high quality maternity care.

 

Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.


 

Antenatal and newborn screening programmes are in place to detect a range of conditions, which might increase disability if not identified early in the antenatal or neonatal period.


Screening programmes offered to pregnant women and their babies after birth are Foetal Anomaly / Downs syndrome, Sickle cell / Haemoglobinopathy Screening, screening for infectious diseases (HIV, Hepatitis B virus), Newborn Bloodspot, Hearing and Newborn /Infant Physical Examination. The UK National Screening Programme has produced a timelinediagram showing when the different programmes are offered to women.


These screening programmes address issues that may have serious consequences for future wellbeing and quality of life. To take Newborn Hearing Screeningas an example, there are approximately 900 children born a year in the UK with significant permanent hearing impairment and one to two babies in every 1,000 are born with a hearing loss in one or both ears. Hearing impairment can cause delay in the acquisition of language and communication skills, and in some cases, there is a consequent longer-term risk to education achievement, mental health and quality of life. All parents of newborns should be offered a hearing test for their baby within two weeks of birth.


National Institute for Health and Clinical Excellence’s guidance report on Antenatal Care (2008)


Guidelines cover advice and information to be given to women during pregnancy, including antenatal and newborn screening programmes, screening for clinical conditions such as gestational diabetes and preeclampsia, screening for infections, lifestyle advice, provision of care and management of pregnancy symptoms and breastfeeding.


National Institute for Health and Clinical Excellence’s guidance report on Antenatal Care and postnatal mental health (2007)


Guidelines provide recommendations for predicting, diagnosing and treating women with mental health problems in the antenatal and postnatal periods.

The antenatal and new-born screening programmes are commissioned at maternity unit level and the data is reported at the same level. Breaking this data down any further is likely to make it inaccurate and less reliable.


The majority of Wokingham Borough residents access Royal Berkshire Hospital for their maternity care. So, the data related to the maternity unit at Royal Berkshire Hospital (RBH) is presented here.


Antenatal Screening

All pregnant women are offered screening for four infections: hepatitis B, HIV, syphilis and susceptibility to rubella. If infected with HIV, Hepatitis B and syphilis, they are offered care and treatment to reduce the risk of passing the infection to their baby, and for their own health and wellbeing. Women who are rubella susceptible are offered the Measles, Mumps and Rubella (MMR) jab to protect future pregnancies.


The Royal Berkshire Hospitals antenatal screening coverage for HIV infection is consistently high and well above the national target level of 90% (Figure 1).

Figure 1: Antenatal screening coverage for HIV infection at Royal Berkshire Hospital (2011/12 8211; 2013/14)

Antenatal hiv screening

Pregnant women who are Hepatitis B positive should be referred and seen by an appropriate specialist within an effective timeframe (6 weeks from identification). The national target is for 70% of women referred for specialist assessment in a timely manner. Figure 2 shows that the proportion of timely referrals at the Royal Berkshire Hospital was above the expected target in the last two quarters. The number of women testing positive for Hepatitis B during antenatal screening are relatively low, so the proportions referred in a timely manner can vary quite dramatically.


Figure 2: Timely referral of hepatitis B positive women for specialist assessment at Royal Berkshire Hospital (2011/12 2013/14)

Antenatal hepatitus

Screening coverage and the completion of Family Origin Questionnaire (FOQ) for antenatal sickle cell and thalesseamia was just above or comparable to the national target of 95% and 90% respectively during 2012/13.


Figure 3: Antenatal screening coverage for sickle cell / Thalesseamia at Royal Berkshire Hospital (2011/12 2013/14)

Antenatal sickle cell

Downs syndrome screening, as measured by completed laboratory request forms, was just below the national target of 97% (Figure 4).


Figure 4: Antenatal screening coverage for Downs syndrome at Royal Berkshire Hospital (2011/12 2013/14)


Downs screening

Newborn Screening

Newborn bloodspot screening, as assessed by timeliness of result, was above the national target of 95%at the Royal Berkshire Hospital.


Newborn hearing screening coverage was consistently high and above the national target of 95% for Royal Berkshire Hospital (figure 5).


Figure 5: Newborn hearing screening coverage at Royal Berkshire Hospital (2011/12 2013/14)

Newborn screening

Overall, antenatal and newborn screening programmes continue to perform well except in a few areas related to newborn bloodspot programme. Improving access to good antenatal healthcare, including the range of antenatal screening programmes, is essential in order to identify needs and risks to mothers and babies at an early stage.


A review of published UK studies in 2004 found some evidence to suggest there may be inequalities in access to pre-natal testing. Some studies suggested that women of South Asian origin might be up to 70% less likely to receive prenatal testing for haemoglobin disorders and Down's syndrome than White women. A small number of studies suggested that South Asian women might be less likely to be offered testing.


Data from the local Area Team is required in order to inform local understanding of antenatal and newborn screening uptake and trends, and to put in place evidence-based interventions to improve screening uptake, particularly in women who are less likely to take it up


Data taken from the NHS England Thames Valley Antenatal and Newborn Screening Dashboard (restricted access)