Identifying sociomedical risk factors during pregnancy: recommendations from international evidence-based guidelines

Abstract

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.

Integrative review of the literature on screening for gender‐based violence during pregnancy: Barriers, facilitators, and tools

“…Of the 23 included studies, n = 14 (60.9%) (Baird et al, 2015; Bermele et al, 2018; Bianchi et al, 2016; Chisholm et al, 2017; Colombini et al, 2017; Damra et al, 2015; Duchesne et al, 2020; Eustace et al, 2016; Garnweidner‐Holme et al, 2020; Gómez Fernández et al, 2017; Halpern‐Meekin et al, 2019; Marques et al, 2017; Mauri et al, 2015; Wild et al, 2019) presented findings on barriers and facilitators related to screening for GBV during pregnancy and n = 8 (34.8%) (Bermele et al, 2018; Bianchi et al, 2016; Chisholm et al, 2017; Escribà‐Agüir et al, 2016; Fletcher et al, 2016; Kataoka & Imazeki, 2018; O'Doherty et al, 2015; Reinsperger et al, 2015) reported information on screening instruments. A total of n = 7 (30.4%) articles were review studies (Bianchi et al, 2016; Chisholm et al, 2017; Colombini et al, 2017; Fletcher et al, 2016; Hahn et al, 2018; O'Doherty et al, 2015; Reinsperger et al, 2015), and n = 10 (43.5%) were qualitative studies (Bacchus et al, 2016; Damra et al, 2015; Eustace et al, 2016; Garnweidner‐Holme et al, 2020; Gómez Fernández et al, 2017; Kataoka & Imazeki, 2018; Marques et al, 2017; Mauri et al, 2015; Spangaro et al, 2016; Wild et al, 2019). Information on the type of design of the included studies can be found in Table 3.…”

“…The facilitators in this category were the availability of guidelines, protocols, and policies to support screening (Bianchi et al, 2016; Colombini et al, 2017; Duchesne et al, 2020; Gómez Fernández et al, 2017; Hahn et al, 2018; Halpern‐Meekin et al, 2019; Marques et al, 2017; Wild et al, 2019) and efficient screening tools (Bermele et al, 2018; Bianchi et al, 2016; Chisholm et al, 2017; Hahn et al, 2018; Kataoka & Imazeki, 2018; Mauri et al, 2015); the use of simple, direct screening questions (Reinsperger et al, 2015); and the use of technology to facilitate screening (Bacchus et al, 2016; Chisholm et al, 2017; Garnweidner‐Holme et al, 2020).…”

“…The review by Reinsperger et al (2015) includes the Hurt, Insult, Threaten, Scream tool (HITS; Sherin et al, 1998); the Ongoing Abuse Screen (OAS; Weiss et al, 2003), the Ongoing Violence Assessment Tool (OVAT; Ernst et al, 2004); the Slapped, Threatened or Thrown Scale (STaT; Paranjape & Liebschutz, 2003); the Humiliation, Afraid, Rape, and Kick questionnaire (HARK; Sohal et al, 2007); the Childhood Trauma Questionnaire–Short Form (CTQ‐SF; Bernstein et al, 2003); and the Women Abuse Screening Tool (WAST; Brown et al, 1996) and adds the use of direct and indirect questions. Meanwhile, Chisholm et al (2017) cover the use of the HITS (Sherin et al, 1998), the OAS (Weiss et al, 2003), the OVAT (Ernst et al, 2004), the STaT (Paranjape & Liebschutz, 2003), the CTQ‐SF (Bernstein et al, 2003), the WAST (Brown et al, 1996), and the Abuse Assessment Screen (AAS; McFarlane et al, 1992), identifying the HARK (Sohal et al, 2007) as the most robust instrument.…”

“…In recent decades, a wide range of instruments designed to detect different aspects of GBV in different groups has emerged (Haggerty et al, 2011); however, no consensus has yet been reached to detect GBV among pregnant women. Most of the studies consulted in this review (Bianchi et al, 2016; Chisholm et al, 2017; Fletcher et al, 2016; O'Doherty et al, 2015; Reinsperger et al, 2015) agree on the use of instruments such as the WAST (Brown et al, 1996), the OAS (Weiss et al, 2003), the OVAT (Ernst et al, 2004), and the HITS (Sherin et al, 1998), but they were not designed for use in antenatal care (e.g., the WAST was validated for the general population by Pichiule Castañeda et al, 2020). Although the AAS (McFarlane et al, 1992) remains the most widely used instrument (Fletcher et al, 2016) and has been validated in different languages for pregnant women (e.g.…”

“…Escribà‐Agüir et al, 2016), it displays certain methodological shortcomings that limit its efficacy (Fletcher et al, 2016). Some of the studies reviewed (Chisholm et al, 2017; Fletcher et al, 2016; Reinsperger et al, 2015) point to the HARK (Sohal et al, 2007) as a valid alternative, as it evaluates all types of GBV and covers efficacy, ease, and speed of administration in a balanced manner (Fletcher et al, 2016). However, there is a lack of validation studies in pregnant women of different origins and in different settings.…”