Pregnancy Screening Programmes
National Services Division has an ongoing role in the national multidisciplinary groups which monitor and evaluate the pregnancy screening programmes.
Pregnancy screening identifies mother and babies who may have rare but serious conditions. Most mothers and babies screened will not have any of the conditions but, for the small number that do, the benefits of screening are enormous. Early treatment can improve their health and prevent severe disability or even death. There are two types of test:
- Screening tests, which are offered to everyone, and are intended to show whether there is a chance you and your baby may have a condition.
- Diagnostic tests, which are further tests that may be carried out depending on the results of the screening test, to confirm what, if any, problem there may be.
While screening offers a good way to assess how likely it is that your baby has a condition or health problem, it may not detect all problems. If you do not want to be screened for any (or all) of the conditions, please talk this through with your midwife or doctor.
The Pregnancy and Newborn Screening Timeline has been developed to show parents and professionals the order of antenatal and newborn screening tests.
Pregnancy and Newborn Screening Timeline [1 page, 1.42Mb]
All pregnant women in Scotland are offered pregnancy screening for the following conditions:
Communicable diseases
These include Rubella (German measles), Hepatitis B, Syphilis and Human Immunideficiency Virus (HIV):
Rubella in the first 20 weeks of pregnancy can be harmful to your baby. It can in some cases, for example, lead to deafness. Most women were immunised in childhood, therefore protecting you and your baby if you come into contact with the illness during pregnancy. The test will show whether you are immune.
Hepatitis B infection can be passed on from mother to baby during birth. It is a viris that affects the liver, and can be carried in the blood for many years before causing any signs of illness. Immunisation at birth can usually prevent infection in babies born to infected mothers.
Syphilis is an uncommon infection passed on through having sex. It is tested for because if it's not treated it can damage the health of you and your baby. If syphillis is found, it can be quickly and safely treated with antibiotics.
Human Immunodeficiency Virus (HIV) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). Infected women can pass HIV to their babies during pregnancy, childbirth and through breastfeeding. HIV damages the immune system, and destroys the body's defences against infection and disease. It can take years for HIV to do enough damange for someone to become ill. Many women with HIV will not know that they are infected unless they have a test. If the test shows that you are HIV positive, you will be offered guidance and treatment by specialists. This will include medication that will greatly reduce the chance of infection passing to your baby. You will also receive advice about the best type of delivery and methods of feeding your baby.
The protocols document contains standard national protocols for all healthcare professionals involved in the NHS Scotland Communicable Diseases Screening Programme. In order to ensure equity of service across Scotland, NHS Boards are required to ensure that the screening service provided locally adheres to these protocols.
Communicable Diseases Screening Programme Protocols [36 pages, 364Kb]
Haemoglobinopathies
The haemoglobinopathies are a large group of inherited blood disorders which affect the haemoglobin (oxygen carrying) component of blood. They fall into two main groups – the haemoglobin variants (such as sickle cell disorders) which are associated with the production of abnormal forms of haemoglobin, and the Thalassaemias in which there is an abnormality in the amount of haemoglobin produced. Many haemoglobinopathies are of no clinical significance whereas others are associated with severe morbidity and mortality, most notably sickle cell disorders and beta thalassaemia major. Sickle cell disorders, caused by a haemoglobin variant, often result in severe life threatening clinical symptoms. Those with beta thalassaemia major require regular blood transfusions to maintain life.
All pregnant women will be offered screening for thalassaemia based on a formal process of inspection of routine blood indices. Additionally Scotland will be following the low prevalence screening model for haemoglobinopathies utilised in England and offering women in high risk groups, or women whose partners are in high risk groups, screening for sickle cell disorders and other haemoglobin variants using a recommended Family Origin (Ancestry) Questionnaire (FOQ) to assess risk status.
The FOQ will be used to improve the screening process by collecting more accurate information of family origins which is highly valuable to laboratories in interpreting results from screening. Where laboratories are able to combine a blood sample with knowledge of the family ancestry of both parents, they are able to make more accurate recommendations about whether the baby’s father should also be invited for screening.
Family Origin Quesionnaire [1 page, 133Kb]
The protocols document contains standard national protocols for all healthcare professionals involved in the NHS Scotland Antenatel Haemoglonopathies screening programme. In order to ensure equity of service across Scotland, NHS Boards are required to ensure that the screening service provided locally adheres to these protocols.
Antenatel Haemoglobinoapthies Screening Programme Protocols [28 pages, 618Kb]
Down’s syndrome
Most people have 23 pairs of chromosomes. These chromosomes carry the genes that determine how we develop. People with Down's syndrome (sometimes called 'trisomy 21') have an extra copy of chromosome 21 - they have three instead of two. It is a chromosomal accident and is not caused by anything parents do before or during pregnancy. It is sometimes inherited, but this is very rare. Older mothers are more likely to have a baby with Down's syndrome, but it can occur in women of any age.
Fetal Anomalies
All women are offered a mid pregnancy scan. It usually takes place between 18 and 21 weeks. The main purpose is to look for anything that might affect the health of your baby. During the scan, the health professional will take a very careful look at your baby. Most people find that their baby is healthy and developing well. Sometimes, however, a problem is found. In most cases, any problems are minor and the health professional taking care of you will be able to explain them to you. Rarely, some serious problems are detected.
The protocols document contains standard national protocols for all healthcare professionals involved in the NHS Scotland Down’s and fetal Anomaly screening programme. In order to ensure equity of service across Scotland, NHS Boards are required to ensure that the screening service provided locally adheres to these protocols.
Scottish Down's syndrome and Fetal Anomaly Screening Programmes Protocols [67 pages, 508Kb]
Future enhancements to the Pregnancy Screening Programme
There are a further developments to the Down's syndrome screening programme, which are to be implemented by September 2011. These are detailed in the CMO letter below
Chief Medical Officer (CMO) Letter - issued May 2011 [4 pages, 50Kb]
These developments are a further enhancement to those deatiled in the Chief Executive's Letter 31 (2008) below.
Chief Executive’s Letter (CEL) 31 - issued July 2008 [7 pages, 220Kb]
Patient Infomation Leaflets
NSD work in partnership with NHS Health Scotland to produce information on tests available during pregnancy. This information is available from the NHS Health Scotland website.
NHS Quality Improvement Scotland
NHS Quality Improvement Scotland, in collaboration with the services and NSD, have developed quality standards relating to the pregnancy and newborn screening programmes; these are available for download from the NHS Quality Improvement Scotland website.
Useful links
The useful links provide further information to members of the public and health professionals.
National Services Division contacts:
To contact members of NSD staff, please visit our staff contacts page.
Lyn Hutchison, Programme Manager, Pregnancy Screening
Marie Richmond, Assistant Programme Manager, Pregnancy Screening
Jenny Dowswell, Programme Support Officer, Pregnancy Screening
