The UK's National Institute for Clinical Excellence (NICE) and the National Collaborating Centre for Women's and Children's Health have published recommendations for the National Health Service in England and Wales on the routine care of healthy pregnant women. The NICE guidance includes advice on how many antenatal appointments each woman should have and what should happen at each one, and on what information should be provided to enable pregnant women to make informed decisions. It also advises what provisions should be made for antenatal screening for a range of conditions, including gestational diabetes, HIV (human immunodeficiency virus) and Down syndrome.

Currently, women with uncomplicated pregnancies have about 14 antenatal appointments, and perhaps visit a hospital for screening, beginning after the 12th week of pregnancy. The new NICE guidelines suggest that these check-ups should begin earlier in the pregnancy, and that the total number of appointments should be reduced to about ten in a first pregnancy and seven in later pregnancies. The recommendations have been made as part of an effort both to standardise antenatal care and to provide women with important information early in their pregnancies. Reducing the number of checks to women with healthy pregnancies would enable more time to be spent with each woman more attention to be given to women with problems or complications.

The guidelines also say that all pregnant women should be offered one of a number of proven, non-invasive methods of screening for Down syndrome, whatever their age, while routine screening for gestational diabetes should be avoided. It also says that women and their partners should receive full information and comprehensive advice about any test they decide to take. Two years ago, the National Screening Committee (NSC) also recommended that by 2004, all pregnant women should be offered non-invasive Down syndrome screening. At that time, according to the NSC, around 80 per cent of pregnant women were already being offered such tests, although there were wide variations in the standards, tests and counselling support available. Dr Peter Brocklehurst, leader of the group behind the new NICE guideline, said that the aim of the recommendation about testing was 'to make sure all women are given information to make informed choices about a range of tests available in pregnancy, including those for Down syndrome'. While he acknowledged that this may increase detection rates and potentially, therefore, terminations of pregnancy, he added 'some women may not want to know, and some may carry a Down's baby and decide to keep it'.

Critics of the recommendations argue that because extra screening could double the number of babies found to have Down syndrome before birth, it would increase the rate of abortion. In addition, the proposed testing in early pregnancy (blood tests and a scan of the fetus' neck) misses four out of ten cases of Down syndrome but also gives 'false positives', where Down syndrome is detected but is not actually present. Such results, warn critics, will increase the rate of miscarriage, as an invasive test such as amniocentesis (which carries a risk of miscarriage) can later be used to provide a diagnosis. Alison Davis, of the pro-life group No Less Human called the NICE recommendations 'fatal discrimination', adding 'the covert message is that if there is anything 'wrong' with the baby, it should be aborted'. But the Down's Syndrome Association has said that it welcomes extended screening procedures, as long as women are given full information about the condition itself, as well as about the tests they are offered.