National guidelines on antenatal care: a survey and comparison of the 25 member states of the European Union

Patient mobility and its implications for patient safety become increasingly import throughout the European Union (EU). Before extending cross-border care further, differences in the approaches to similar health problems need to be known. With regard to antenatal care, there are sufficient differences in the national guidelines to produce gaps or an unnecessary, expensive and possibly harmful multiplication of tests for pregnant women. As it was perceived impossible to gain a quick and comprehensive overview of what the recommendations in the member states of the EU are, further investigations were needed to address this. Moreover, a comprehensive review of the content of national guidelines on antenatal care was required to find out whether a common minimum guideline would be beneficial, and what this guideline might contain. A model needed to be developed for integrating existing guidelines to a common minimum guideline to complement national health policies. In a survey, the Ministries of Health and equivalent bodies, as well as the societies of obstetricians and midwives, were asked to fill in a structured questionnaire on their national guidelines for antenatal care. Descriptive analyses identified which and how many states recommend a test and to how many people this applied. The tests which were recommended by more than 50% of the states and applied to more than 50% of the inhabitants of the EU were compared to the measures supported by scientific evidence. Finally, it was explored whether there was a correlation between the gross national product (GNP) and the number of tests recommended. At least one representative of all 25 member states of the EU returned a completed questionnaire. Twenty of the member states were found to have a national guideline, within which, 47 tests were reported and 23 of which are recommended for routine care by more than 50% of the states and apply to more than 50% of inhabitants. Those 23 tests are also supported by scientific evidence. Countries with a GNP below EU average were found to recommend more tests than the others. This study presents in detail what the national guidelines of the member states of the EU recommend for antenatal care. These findings demonstrate for the first time that extracting the measures from national guidelines that are recommended by the majority of states and apply to the majority of inhabitants of the EU leads to the development of a guideline compatible with scientific evidence. On the basis of these findings, a common minimum guideline for antenatal care in the EU should be established.