What are the recommended clinical assessment and screening tests during pregnancy?
Authors: Gyselaers Wilfried , Jonckheer Pascale , Ahmadzai Nadera , Ansari MT , Carville Serena , Dworzynski Katharina , Gaudet Laura , Glen Jessica , Jones Katie , Miller Paul , Tetzlaff Jennifer Marie , Alexander Sophie , Allegaert Karel , Beeckman Katrien , Ceysens Gilles , Christiane Yolande , De Ronne Nadine , De Thysebaert Bénédicte , Dekker Nicole , Denys Alexandra , Eeckeleers Patricia , Hernandez Ana , Mathieu Evelyne , Seuntjens Lieve , Verleye Leen , Stordeur Sabine 
Published: January 2025

LIST OF FIGURES 7 -- LIST OF TABLES 12 -- 1. COMPOSITION OF EXPERTS AND STAKEHOLDERS GROUPS 24 1.1. COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP 24 -- 1.2. COMPOSITION OF THE STAKEHOLDERS GROUP 25 -- 1.3. COMPOSITION OF THE KCE EXPERT TEAM 25 -- 1.4. EXTERNAL RESEARCHERS INVOLVED IN THE GUIDELINE DEVELOPMENT 26 -- 2. TOPICS PROPOSED BY THE GDG 27 -- 3. RISK FACTORS THAT MAY IMPLY ADDITIONAL CARE 29 -- 4. PATHWAYS FOR SCREENING OF CMV, TOXOPLASMOSIS AND GESTATIONAL DIABETES 32 -- 4.1. CYTOMEGALOVIRUS 32 4.2. TOXOPLASMOSIS 33 -- 4.3. GESTATIONAL DIABETES 34 -- 5. P.I.C.O. FOR FULL SEARCH QUESTIONS 37 -- 5.1. CYTOMEGALOVIRUS 37 5.2. TOXOPLASMOSIS 39 -- 5.3. CHLAMYDIA TRACHOMATIS 41 -- 5.4. GROUP B STREPTOCOCCUS 42 -- 5.5. GESTATIONAL DIABETES 43 -- 5.6. HYPOTHYROIDISM 45 -- 5.7. VITAMIN D DEFICIENCY 47 5.8. RISK OF PRETERM BIRTH 48 -- 5.9. RISK OF PREECLAMPSIA 51 5.10. SURVEILLANCE OF PREGNANCIES THAT PASSED THEIR DUE DATE 52 -- 6. SEARCH STRATEGIES 54 -- 6.1. SEARCH STRATEGY FOR GUIDELINES 54 -- 6.2. SEARCH STRATEGIES FOR OTHER PUBLICATIONS (SYSTEMATIC REVIEWS, METAANALYSES, INDIVIDUAL STUDIES) FOR FULL SEARCH QUESTIONS 55 -- 6.2.1. Cytomegalovirus 55 -- 6.2.2. Toxoplasmosis 60 -- 6.2.3. Chlamydia trachomatis 64 -- 6.2.4. Group B streptococcus 69 -- 6.2.5. Gestational diabetes 73 -- 6.2.6. Hypothyroidism 78 -- 6.2.7. Vitamin D deficiency 110 -- 6.2.8. Risk of preterm birth 128 -- 6.2.9. Risk of preeclampsia 179 -- 6.2.10. Pregnancies that passed their due date 200 -- 7. STUDY SELECTION 221 -- 7.1. STUDY SELECTION FOR FULL SEARCH QUESTIONS 221 -- 7.1.1. Cytomegalovirus 221 -- 7.1.2. Toxoplasmosis 222 -- 7.1.3. Chlamydia trachomatis 223 -- 7.1.4. Group B streptococcus 224 -- 7.1.5. Gestational diabetes 225 -- 7.1.6. Hypothyroidism 227 -- 7.1.7. Vitamin D deficiency 229 -- 7.1.8. Risk of preeclampsia 233 -- 7.1.9. Pregnancies that passed their due date 234 -- 8. QUALITY APPRAISAL 235 -- 8.1. QUALITY APPRAISAL TOOLS 235 -- 8.1.1. Guidelines 235 8.1.2. Systematic reviews 236 -- 8.1.3. RCTs 238 8.1.4. Observational studies 240 -- 8.1.5. Diagnostic accuracy studies 241 -- 8.2. QUALITY APPRAISAL OF GUIDELINES 244 -- 8.3. QUALITY APPRAISAL FOR FULL SEARCH QUESTIONS 245 -- 8.3.1. Cytomegalovirus 245 8.3.2. Toxoplasmosis 247 -- 8.3.3. Chlamydia trachomatis 251 -- 8.3.4. Group B streptococcus 252 -- 8.3.5. Gestational diabetes 259 8.3.6. Hypothyroidism 268 -- 8.3.7. Vitamin D deficiency 278 -- 8.3.8. Risk of preterm birth 296 -- 8.3.9. Risk of preeclampsia 308 -- 8.3.10. Pregnancies that passed their due date 308 -- 9. EVIDENCE TABLES 315 -- 9.1. CYTOMEGALOVIRUS 315 -- 9.2. TOXOPLASMOSIS 317 -- 9.2.1. Screening for toxoplamosis 317 -- 9.2.2. Lifestyle advice for toxoplasmosis 325 -- 9.3. CHLAMYDIA TRACHOMATIS 329 -- 9.4. GROUP B STREPTOCOCCUS 333 -- 9.5. GESTATIONAL DIABETES 358 -- 9.5.1. Universal screening vs. selected screening of gestational diabetes 358 -- 9.5.2. Early risk-factor vs. late non-risk factor screening.of gestational diabetes 362 -- 9.5.3. Different screening tests comparison.for gestational diabetes 367 -- 9.5.4. Diagnostic accuracy 370 -- 9.6. HYPOTHYROIDISM 377 -- 9.6.1. Screening for hypothyroidism in asymptomatic pregnancies 377 -- 9.6.2. Therapy for subclinical hypothyroidism during pregnancy 381 -- 9.7. VITAMIN D DEFICIENCY 389 -- 9.7.1. Vitamin D supplementation during pregnancy 389 -- 9.8. RISK OF PRETERM BIRTH 417 -- 9.8.1. Screening for preterm birth risk 417 -- 9.8.2. Progesterone 419 -- 9.8.3. Cerclage 435 -- 9.8.4. Reduced physical activity 443 -- 9.9. PREGNANCIES THAT PASSED THEIR DUE DATE 446 -- 10. SUMMARY OF FINDINGS TABLES AND GRADE PROFILES 461 -- 10.1. CYTOMEGALOVIRUS 461 -- 10.1.1. Lifestyle advice for CMV infection 461 -- 10.2. TOXOPLASMOSIS 462 -- 10.2.1. Screening for toxoplasmosis infection 462 -- 10.2.2. Lifestyle advice for toxoplamosis infection 466 -- 10.3. CHLAMYDIA TRACHOMATIS 468 -- 10.4. GROUP B STREPTOCOCCUS 470 10.5. GESTATIONAL DIABETES 472 -- 10.5.1. Universal screening vs. selected screening 472 -- 10.5.2. Early risk-factor vs. late non-risk factor screening.of gestational diabetes 474 -- 10.5.3. Different screening tests comparison.for gestational diabetes 476 -- 10.5.4. Diagnostic accuracy 479 -- 10.6. HYPOTHYROISDISM 481 -- 10.6.1. Screening for hypothyroidism 481 -- 10.6.2. Therapy for subclinical hypothyroidism 484 -- 10.7. VITAMIN D DEFICIENCY 487 -- 10.7.1. Vitamin D supplementation vs. no vitamin D supplementation 487 -- 10.7.2. Vitamin D + calcium vs. no vitamin D/calcium supplementation 491 -- 10.8. RISK OF PRETERM BIRTH 492 -- 10.8.1. Screening by repeat digital vaginal exam versus no screening 492 -- 10.8.2. Progesterone vs no progesterone to prevent preterm birth 493 -- 10.8.3. Cerclage vs no cerclage to prevent preterm birth 495 -- 10.9. PREGNANCIES THAT PASSED THEIR DUE DATE 498 -- 11. FOREST PLOTS 504 -- 11.1. CMV 504 -- 11.2. TOXOPLASMOSIS 504 -- 11.2.1. Mandatory monthly screening (1992-1995) versus recommended screening (1987-1991) in France121 504 -- 11.2.2. After (1984 - 1990) versus prior (1966) implementation of screening plus treatment53 505 -- 11.2.3. Prenatal screening and treatment (1976  1987) vs. untreated during pregnancy (1966  1975)54 506 -- 11.2.4. Countries with prenatal screening plus treatment policies (1996  2000) vs. countries with neonatal screening programmes (1992  2000)23 507 -- 11.2.5. Lifestyle for toxoplasmosis 508 11.3. CHLAMYDIA TRACHOMATIS 508 -- 11.3.1. Routine screening vs. no routine screening for chlamydia trachomatis 508 -- 11.3.2. Universal screening vs. screening at the discretion of attending medical staff for chlamydia trachomatis 509 -- 11.4. GROUP B STREPTOCOCCUS 510 -- 11.4.1. Universal screening vs. no screening for GBS 510 -- 11.4.2. Universal screening vs. risk based prophylaxis for GBS 511 -- 11.4.3. Universal screening vs. risk based prophylaxis (matched groups without risk factors) 512 -- 11.4.4. Late (35  37 weeks) universal screening vs. early (26  28 weeks) universal screening 512 -- 11.5. GESTATIONAL DIABETES 512 -- 11.5.1. Routine screening vs. selective screening for gestational diabetes 512 -- 11.5.2. Early screening vs. late screening for gestational diabetes 514 -- 11.5.3. Comparisons of different thresholds for the 75g OGTT for screening for gestational diabetes 516 -- 11.5.4. Comparisons of different combinations of GCT and OGTT for screening for gestational diabetes 517 -- 11.6. HYPOTHYROIDISM 520 -- 11.6.1. Therapy for subclinical hypothyroidism 520 -- 11.7. VITAMIN D DEFICIENCY 524 -- 11.7.1. Vitamin D supplementation versus no vitamin D supplementation 524 -- 11.8. RISK OF PRETERM BIRTH 527 -- 11.8.1. Progesterone vs no progesterone 527 -- 11.8.2. Cerclage vs no cerclage 531 -- 11.9. PREGNANCIES THAT PASSED THEIR DUE DATE -- 533 12. EXCLUDED STUDIES 542 -- 13. EXAMPLE OF LIME SURVEY 543 -- 14. SUMMARY OF UPDATING PROCESS OF 2004 RECOMMENDATIONS 545 -- 14.1. NUMBER OF APPOINTEMENTS 545 -- 14.2. BMI 547 14.3. BLOOD PRESSURE 551 -- 14.4. PROTEINURIA 553 -- 14.5. FUNDAL HEIGHT MEASUREMENT 556 -- 14.6. FOETAL POSITION 558 -- 14.7. FOETAL MOVEMENTS COUNTING 560 -- 14.8. FOETAL HEART AUSCULTATION 56 2 -- 14.9. ULTRASOUND SCAN DURING THE FIRST TRIMESTER 564 -- 14.10. ULTRASOUND SCAN AFTER THE FIRST TRIMESTER 567 -- 14.11. ANAEMIA 572 -- 14.12. PLATELETS AND LEUKOCYTES COUNT 574 -- 14.13. BLOOD GROUP, RHESUS AND ATYPICAL RED CELL ANTIBODIES 576 -- 14.14. HAEMOGLOBIN DISORDERS 579 -- 14.15. HEPATITIS B 581 -- 14.16. HEPATITIS C 583 14.17. HIV 586 -- 14.18. RUBELLA 588 -- 14.19. SYPHILIS 590 -- 14.20. HERPES SIMPLEX 592 -- 14.21. VARICELLA 594 -- 14.22. ASYMPTOMATIC BACTERIAL VAGINOSIS 596 -- 14.23. ASYMPTOMATIC BACTERIURIA 598 -- 15. EXTERNAL REVIEW 600 -- 15.1. EVALUATION OF THE RECOMMENDATIONS 600 -- 16. CATEGORIES OF EVIDENCE LEVELS AND GRADE OF RECOMMENDATIONS 605 -- 16.1. KCE 2004 CLASSIFICATION 605 -- 16.2. NICE 2008 CLASSIFICATION 606 -- 16.3. EAC 2014 CLASSIFICATION 607 -- REFERENCES 609