2 Research recommendations
The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The Guideline Development Group's full set of research recommendations is detailed in the full guideline.
Alternative ways of helping healthcare professionals to support pregnant women in making informed decisions should be investigated.
Further research needs to be undertaken to assess the effectiveness, practicality and acceptability of chlamydia screening in an antenatal setting.
Chlamydia is a significant healthcare issue, especially among the young, but the current level of evidence provides an insufficient basis for a recommendation. Of particular importance is the possibility that treatment might reduce the incidence of preterm birth and neonatal complications, and studies should be directed to these areas.
Further prospective research is required to evaluate the diagnostic value and effectiveness (both clinical and cost‑effectiveness) of predicting small‑for‑gestational‑age babies using:
customised fetal growth charts to plot symphysis–fundal height measurement
routine ultrasound in the third trimester.
Poor fetal growth is undoubtedly a cause of serious perinatal mortality and morbidity. Unfortunately, the methods by which the condition can be identified antenatally are poorly developed or not tested by rigorous methodology. However, existing evidence suggests that there may be ways in which babies at risk can be identified and appropriately managed to improve outcome, and this should form the basis of the study.
Multicentred validation studies are required in the UK to evaluate the use of the 'Antenatal assessment tool'. Using structured questions, the tool aims to support the routine antenatal care of all women by identifying women who may require additional care. The tool identifies women who:
can remain within or return to the routine antenatal pathway of care
may need additional obstetric care for medical reasons
may need social support and/or medical care for a variety of socially complex reasons.
The idea of some form of assessment tool to help group pregnant women into low‑risk (midwifery‑only care) and increased‑risk (midwifery and obstetric care) categories is not new. The 'Antenatal assessment tool' has been developed using a consensus approach. Once developed, it will be essential to subject the tool to a multicentred validation study. The validated tool should have the potential to identify a third group of women who are particularly vulnerable and at increased risk of maternal and perinatal death.
There is a need for research into the effectiveness of routine vitamin D supplementation for pregnant and breastfeeding women.
Although there is some evidence of benefit from vitamin D supplementation for pregnant women at risk of vitamin D deficiency, there is less evidence in the case of pregnant women currently regarded as being at low risk of deficiency. It is possible that there will be health gains resulting from vitamin D supplementation, but further evidence is required.