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