Quality standard for antenatal care
Introduction and overview
Most women who are pregnant in the UK will have an uncomplicated pregnancy, giving birth to a healthy baby at full term. However, problems during pregnancy (such as miscarriage, fetal growth restriction and preterm birth) remain common, and stillbirth rates have changed little in recent years. Maternal complications such as depression, thromboembolism, haemorrhage and sepsis are also still encountered, with the most extreme cases contributing to a UK maternal mortality rate of around 11 per 100,000 maternities (2006–2008 data).
Adverse outcomes of pregnancy are sometimes unpredictable events, but can also be associated with risk factors such as obesity, smoking, diabetes, hypertension, substance misuse or domestic abuse. The aims of antenatal care are to optimise maternal and fetal health, to offer women maternal and fetal screening, to make medical or social interventions available to women where indicated, to improve women's experience of pregnancy and birth and to prepare women for motherhood whatever their risk status.
This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for pregnant women in the following ways:
Preventing people from dying prematurely.
Ensuring that people have a positive experience of care.
Treating and caring for people in a safe environment and protecting them from avoidable harm.
These overarching outcomes are from The NHS Outcomes Framework 2012/13.
The quality standard is also expected to contribute to the following overarching outcome(s) from the Public Health Outcomes Framework 2013–16:
Healthcare public health and preventing premature mortality.
The quality standard for antenatal care requires that services should be commissioned from and coordinated across all relevant agencies encompassing the antenatal care part of the maternity pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to pregnant women.
The theme of this quality standard is that pregnancy is a normal physiological process. Women should have the opportunity to make informed decisions about their care and treatment based on the current available evidence, in partnership with healthcare professionals.
This quality standard covers the antenatal care of all pregnant women up to 42 weeks of pregnancy, in all settings that provide routine antenatal care, including primary, community and hospital-based care. The quality standard addresses routine antenatal care, including screening tests for complications of pregnancy, but it does not address the additional care needed to manage these complications if they arise in pregnancy (for example, gestational diabetes, pre-eclampsia and venous thromboembolism).
This quality standard forms part of a suite of maternity quality standards, of which antenatal care, intrapartum care and postnatal care will form the core pathway. The full set of quality standards, including all the maternity quality standards, that should be considered when commissioning and providing high quality maternity services are listed in Related NICE quality standards.
 Centre for Maternal and Child Enquiries (CMACE) (2011) Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. British Journal of Gynaecology 118 (Suppl. 1): 1–203.