Antenatal care in developed countries

When the first programmes for antenatal care were designed in Europe in the first decades of the century, they were directed mainly towards women in socially difficult living conditions, and had as a definite objective the improvement of maternal and perinatal outcome for the least privileged groups.Gradually, the programmes increased their number of objectives and included more specific screening procedures to detect defined medical problems in the whole pregnant population.As maternal and perinatal outcome dramatically improved in the industrialised part of the world, antenatal care was given much of the credit without much evidence of its precise benefits.This established system of antenatal care has now been challenged, firstly in the countries with the most favourable maternal and perinatal health indicators.With the new trend to demand scientific evidence for medical interventions it was realised that there is a great lack of substantive justification for many of the procedures that have been introduced successively into antenatal care.However, it is not easy to conduct controlled scientific trials in this area.Not only is there a strong tradition that pregnant women should be weighed and checked for high blood pressure at certain intervals, but it has also proved difficult to conduct trials of newer screening procedures.For example, routine use of ultrasound was not assessed until it had already become so established in the minds of care providers and women alike that when a large proportion in the control arm of the trials were examined, and when the trials did not prove benefits, they were heavily criticised.The screening for and treatment of gestational diabetes are parts of most antenatal care programmes, but have not been assessed.