Outline of policy for implementation of the Antenatal Screening

The policy for antenatal screening in England is for the phased implementation of a programme which will allow the offer of sickle cell and thalassaemia screening to all women as an integral part of early antenatal care.

Thalassaemia screening using routine blood indices will be offered to all women in England.

The form of screening for haemoglobin variants will depend on the prevalence of the condition. Universal laboratory screening is to be offered in those trusts identified as covering high prevalence populations by end of 2004/5. All other areas will be required to offer, as a minimum, laboratory testing for variants based on an assessment of risk determined by a question to women about their family origin by end of 2005/6.

Antenatal Screening Policy

A policy statement for implementing Antenatal Screening is now available. Please click on Policy Statement for an electronic copy.

A copy of the Policy document that went to the UK National Screening Committee in December 2003 can be obtained by clicking on NSC Policy Dec 03.

High prevalence areas should begin to prepare for universal screening from 2002 onwards (according to their state of readiness).

Recommendations for the Antenatal Screening Policy

1) All areas of England must offer an antenatal screening programme for Sickle Cell and Thalassaemia.

2) The programme should be delivered though primary care general practices working with maternity services as part of an integrated antenatal programme offered to all women.

3) The process should start as soon as possible after confirmation of pregnancy. Ideally the whole process including the offer, uptake and reporting of results of prenatal diagnosis and any subsequent action should be completed before the end of the first trimester.

4) Women must have adequate information provided to them in appropriate formats to ensure that they understand that sickle cell and thalassaemia screening is offered as part of their antenatal care. It should outline the aims and processes of the programme to allow informed decision making in a time suited to their needs.

5) Professionals caring for women and their partners during pregnancy must be adequately informed about the programme to be able to support women and their partners in the decision-making process.

6) Audit and evaluation is required as part of the overall quality assurance of the programme, including annual reports from the individual programmes on the process and outcome of their programmes.

Details of the programme recommended:

The type of screening programme will depend on the trust concerned as whether it is defined as a 'high prevalence' or 'low prevalence'.

Thalassaemia screening using routine blood indices should be offered to all women in England.

The type of screening for haemoglobin variants (e.g. HbS, HbC etc) will depend on the prevalence of the condition:-

Areas, defined as low prevalence, will be required to offer, as a minimum, laboratory testing for variants based on an assessment of risk determined by a question to women about their ethnic origin.

Universal laboratory screening of all women to be offered in trusts defined as covering high prevalence populations.

Implementation

Roll out of the Antenatal Screening Programme will begin from 2003. Further information is needed to inform policy decisions about the best approach to medium and low prevalence areas. This includes better information on the feasibility and practicality of an 'ethnic' question (research that has been commissioned).

Relevant documents

The following documents on Antenatal Screening are now available:

• Antenatal Laboratory Standards
• Antenatal Screening Algorithms
• A laboratory newsletter
• Referral guidance for antenatal laboratories
• Purchasing arrangements

These documents are available for viewing or printing on the Antenatal Section of the Laboratory Policies webpage.

Prevalence of Haemoglobinopathies in Acute Trusts

Updated lists of both High Prevalence Trusts and Low Prevalence Trusts are now available by clicking on the links below:

High Prevalence Trusts

Low Prevalence Trusts