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Lab Tests During Pregnancy: Are They Done as Per Guidelines

Published on 24 February, 2012
Lab Tests During Pregnancy: Are They Done as Per Guidelines
Tests carriedout during pregnancy do not correlate with the actual guidelines for thesetests, according to a recent study. 

 Prenatal care or care during pregnancy is necessaryto ensure a healthy mother and a healthy baby. The U.S. Preventive ServicesTask Force (USPSTF) has recommended that some tests should be included as apart of routine prenatal care. It has suggested recommendations for tests likeurine culture, anemia screening, oral glucose tolerance test and urinalysisduring pregnancy.

 A urineculture is used to diagnose the presence of bacteria in the urine. A urineinfection can lead to low birth weight babies. As per the guidelines, this screening test should be done once early inpregnancy.

Anemia is detected through bloodtests that measure hemoglobin levels and hematocrit. Anemia in pregnancyincreases the risk for low birth weight, preterm delivery, and death of thebaby during delivery. The guidelinesalso suggest doing this test during pregnancy.

Diabetes in pregnancy may lead tocomplications like big babies, low blood sugar in the baby post delivery,premature delivery, birth injury, intensive neonatal care admission, andjaundice in the newborn. It can also predispose the mother to preeclampsia. Diabetes in pregnancy is diagnosed usingoral glucose tolerance test, though the evidence of any benefit for doing thetest is considered insufficient by the USPSTF.

  Urinalysis is a test where the urine istested for infection, presence of protein or glucose in the urine. This test isnot recommended for routine purpose by the USPSTF.

A study wasconducted to evaluate the use of these tests in pregnant women in the UnitedStates and whether they were as per the recommendations of the USPSTF. Data collected includedrace, age, region, payer type and pregnancy status in terms of being high orlow risk.

 Most of the women included in the study were White,in their 20s, paid for their visit using private insurance and were in thelow-risk group.

 During the years 2003 and 2004, urine cultures weredone 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 averageof 1.4 screenings per pregnancy between the years 2001 and 2003. The averagereduced 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 conductedbetween 2003 and 2006, though the guidelines suggest there is insufficientevidence to suggest or disapprove the testing.

 Urinalysis was done at an average of 5.6 perpregnancy between 2001 and 2003. Between 2004 and 2006, the average reduced to4.3 per pregnancy. The number ofurinalysis done was far more than recommended. However, the number has beendeclining over the last few years.

 The study also found that women from minoritycommunities like Hispanics and Blacks and women between the ages of 30 and 34years are more often tested for urine cultures, anemia screenings, and oralglucose tolerance tests than white women and younger women.

Thus, what isfollowed in practice appears to be quite different from what is actuallyrecommended. A better adherence to the recommended guidelines could go a longway in improving prenatal care.

Reference:

 1. Screening Tests During Prenatal Care; Juned Siddique et al; Maternaland Child Health Journal 2012.

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