This section discusses the evidence for offering women a range of tests for women identified as at increased risk (see Table G1). Recommendations are based on evidence about the diagnostic accuracy of available tests, the effectiveness of interventions to prevent mother-to-child transmission of infection or other effects on the unborn baby, and the availability of treatments.
For notifiable infections (chlamydia, gonorrhoea), diagnoses are required to be reported to the National Notifiable Diseases Surveillance System. This allows analysis of trends in jurisdictions and groups at risk, although data quality varies for the different conditions and reporting of Indigenous status is incomplete in some States and for some conditions. Evidence on the prevalence and incidence of other conditions is generally from observational studies and may not be representative of the Australian population or groups within the population. While incidence or prevalence data are not always available, each chapter includes a brief discussion that aims to give health professionals an indication of the likelihood that women in their community will be affected.
| Condition | Offer test to: | Test(s) | Rationale/follow-up |
|---|---|---|---|
| Chlamydia* |
Women younger than 30 years All pregnant women in areas of high prevalence |
First pass urine NAAT | Treatment may reduce the risk of preterm birth, premature rupture of the membranes and low birth weight |
| Gonorrhoea* | Women with known risk factors or living in areas where prevalence is high | Vaginal, urine or endocervical specimens NAAT | Treatment may prevent neonatal infection |
| Trichomoniasis* | Women with symptoms | PCR testing of vaginal swabs | Treatment may prevent certain infections in the newborn but is associated with adverse effects |
| Toxoplasmosis | Women may request testing based on exposure to sources | Studies into tests are limited and inconclusive | Insufficient evidence on treatment. Advice on prevention may reduce the risk of infection |
| Cytomegalovirus | Women who have frequent contact with large numbers of very young children | Studies into tests are limited and inconclusive | Advice on prevention may reduce the risk of infection; seek expert advice if infection is identified |
| Hyperglycaemia | Women with risk factors for hyperglycaemia | Glycated haemoglobin or fasting blood glucose | Hyperglycaemia can be minimised during pregnancy to improve outcomes |
| Asymptomatic bacterial vaginosis | Women with a previous preterm birth | High vaginal swab Amsel’s criteria Nugent’s criteria | Early treatment (<20 wks) may reduce risk of premature rupture of the membranes and low birth weight |
| Thyroid function | Women with symptoms or risk factors | Blood test for thyroid-stimulating hormone | Treatment improves maternal and newborn outcomes |
| Vitamin D status | Women considered to be at risk | Blood test for serum 25-OHD | Women at high risk of deficiency may benefit from supplementation |
| Human papilloma virus | Women who have not had a cervical screen in the recommended time period | Pap smear | Allows detection of precancerous cervical abnormalities |
|