antenatal care (criteria for requiring additional care)

Last reviewed 08/2021

NICE offers recommendations on baseline clinical care for all pregnant women but it does not offer information on the additional care that some women will require. Pregnant women with the following conditions usually require care additional to routine antenatal care (1):

• cardiac disease, including hypertension
• renal disease
• endocrine disorders or diabetes requiring insulin
• psychiatric disorders (being treated with medication)
• haematological disorders
• autoimmune disorders
• epilepsy requiring anticonvulsant drugs
• malignant disease
• severe asthma
• use of recreational drugs such as heroin, cocaine (including crack cocaine) and ecstasy
• HIV or HBV infection
• obesity (body mass index 30 kg/m2 or above at first contact) or underweight (body mass index below 18 kg/m2 at first contact)
• higher risk of developing complications, for example, women aged 40 and older, women who smoke
• women who are particularly vulnerable (such as teenagers) or who lack social support

Women who have experienced any of the following in previous pregnancies:

• recurrent miscarriage (three or more consecutive pregnancy losses or a mid-trimester loss)
• preterm birth
• severe pre-eclampsia, (H) hemolytic anaemia, (EL) elevated liver enzymes, and (LP) low platelet count (HELLP syndrome) or eclampsia
• rhesus isoimmunisation or other significant blood group antibodies
• uterine surgery including caesarean section, myomectomy or cone biopsy
• antenatal or postpartum haemorrhage on two occasions
• puerperal psychosis
• grand multiparity (more than six pregnancies)
• a stillbirth or neonatal death a small-for-gestational-age infant (below 5th centile)
• a large-for-gestational-age infant (above 95th centile)
• a baby weighing below 2.5 kg or above 4.5 kg
• a baby with a congenital abnormality (structural or chromosomal)

Reference:

NICE (March 2016). Antenatal care for uncomplicated pregnancies