Centre for Midwifery, Child and Family Health, UTS Sydney, Sydney, NSW
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC.
Med J Aust. 2018 Nov 5;209(9):409-412. doi: 10.5694/mja18.00286.
The clinical practice guidelines on pregnancy care have been developed to provide reliable and standardised guidance for health professionals providing antenatal care in Australia. They were originally released as the Clinical Practice Guidelines: Antenatal Care in two separate editions (modules 1 and 2) in 2012 and 2014. These modules have now been combined and updated to form a single set of consolidated guidelines that were publicly released in February 2018 as the Clinical Practice Guidelines: Pregnancy Care. Eleven topics have been updated and new guidance on substance use in pregnancy has been added. Main recommendations: The updated guidelines include the following key changes to practice: recommend routine testing for hepatitis C at the first antenatal visit; recommend against routine testing for vitamin D status in the absence of a specific indication; recommend discussing weight change, diet and physical activity with all pregnant women; and recommend offering pregnant women the opportunity to be weighed at every antenatal visit and encouraging women to self-monitor weight gain. Changes in management as a result of the guidelines: The guidelines will enable pregnant women diagnosed with hepatitis C to be identified and thus avoid invasive procedures that increase the risk of mother-to-baby transmission. Women can be treated postpartum, reducing the risk of liver disease and removing the risk of perinatal infection for subsequent pregnancies. Routine testing of all pregnant women for vitamin D status and subsequent vitamin D supplementation is not supported by evidence and should cease as the benefits and harms of vitamin D supplementation remain unclear. The recommendation for health professionals to provide advice to pregnant women about weight, diet and physical activity, and the opportunity to be weighed will help women to make changes leading to better health outcomes for themselves and their babies.
《妊娠保健临床实践指南》的制定旨在为在澳大利亚提供产前护理的卫生专业人员提供可靠和标准化的指导。这些指南最初于 2012 年和 2014 年以《临床实践指南:产前护理》的两个单独版本(模块 1 和 2)发布。这两个模块现在已经合并并更新,形成了一套单一的综合指南,并于 2018 年 2 月作为《妊娠保健临床实践指南》公开发布。有 11 个专题进行了更新,并新增了关于妊娠期间物质使用的新指导意见。主要建议:更新后的指南包括以下对实践的重大改变:建议在首次产前检查时常规检测丙型肝炎;不建议在没有特定指征的情况下常规检测维生素 D 状况;建议与所有孕妇讨论体重变化、饮食和身体活动;并建议为孕妇提供每次产前检查时称重的机会,并鼓励妇女自我监测体重增加。由于指南而改变的管理:该指南将使被诊断患有丙型肝炎的孕妇得到识别,从而避免增加母婴传播风险的侵入性程序。女性可以在产后接受治疗,降低肝脏疾病的风险,并消除随后妊娠的围产期感染风险。对所有孕妇进行维生素 D 状况的常规检测和随后的维生素 D 补充并没有得到证据的支持,应该停止,因为维生素 D 补充的益处和危害仍不清楚。建议卫生专业人员向孕妇提供有关体重、饮食和身体活动的建议,并为她们提供称重的机会,这将有助于妇女做出改变,从而为自己和婴儿带来更好的健康结果。