Aim Sociomedical risks are common problems during pregnancy and can have serious health consequences for both mother and child. They are frequently underestimated within prenatal care programmes, although routine screening could help identify women in need of additional support. The aim of this article was to systematically summarise risk assessment and screening recommendations for mental health problems, depression, substance misuse and intimate partner violence during pregnancy using evidence-based guidelines, in order to provide a decision support for healthcare professionals and policy-makers. Subjects and methods A systematic literature search in two guideline databases was carried out and websites of international institutions developing evidence-based guidelines were searched. Guidelines from Western, industrialised countries, published in English or German since 2007 and providing recommendations for sociomedical screenings during pregnancy were included. Furthermore, guidelines had to be based on a systematic literature search in at least two databases and had to involve recommendations explicitly linked to the evidence. Results Sixteen guidelines, developed by nine institutions from Europe, the United States, Canada and Australia, met the inclusion criteria. The majority of the guidelines recommended routine assessment, although some conflicting recommendations were found for depression, illicit drug use and violence. Conclusion Our research findings suggest that screening or assessment for the analysed risk factors is advisable. However, the assigned grades of recommendation reflect that the evidence base is limited. Further research should also concentrate on evaluating different screening methods, as there was little consensus on the ideal screening test.

The variety of grades of recommendations hamper across-guideline comparison. Nevertheless, the article highlights agreed screening areas based on the best available evidence as well as areas of still existing uncertainty. Local health policy decisions on whether to include or refrain from including screening measures in preventive care programmes can be facilitated by the comparison of recommendations from international evidence-based guidelines. Beyond the availability of evidence each country's health policy makers will have to make a judgement on the value of the test for a population-wide screening.

No abstract

Background Pregnant women frequently use prenatal screening and diagnostic tests to detect fetal structural and chromosomal anomalies; however, the regulation and financing of these examinations differ substantially across countries. In this paper we focus on the provision, financing and setting of the following tests in selected European countries: First Trimester Screening (FTS)/Combined Test (CT), Non-invasive Prenatal Test (NIPT), second-trimester ultrasound screening for fetal anomalies, amniocentesis/chorionic villus sampling. Methods We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy. We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire. Results The results are based on 11 completed expert questionnaires and 22 published sources. The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists). There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester. Conclusions The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies. Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary. Decision-makers should pay particular attention to high-quality and non-directive counselling. Key messages

Non-communicable diseases (NCDs) are the leading cause of death worldwide and are responsible for a high burden of disease. Many countries have developed national strategies for the management and prevention of NCDs to improve the care of chronically ill people or prevent NCDs. This article aims to provide an overview of national NCD strategies from selected countries and their implementation. The focus was on cardiovascular and chronic respiratory diseases, diabetes type II, and depression. A comprehensive, structured hand search was conducted in various databases and websites for national strategies on the 4 NCDs. According to pre-defined criteria, 18 strategies from 8 countries (Germany, Switzerland, Netherlands, Finland, Ireland, United Kingdom, Canada, Australia) were selected. The included NCD strategies differ considerably in terms of level of detail, structure and implementation. All strategies include information on planned activities, but only a few provide detailed information on these interventions, including their evaluation. A structured approach from the macro to the micro level seems crucial for a comprehensive, coordinated overall policy. Strategies should be evaluated regularly using appropriate methods to measure target achievement. For the prevention and management of NCDs, it is important to start in early childhood and to adequately consider the social determinants of health with a “Health in All Policies” approach.