gms | German Medical Science

Background: Pregnancy check-ups are preventive services and part of the benefits catalogue of the health insurance funds. The contents of antenatal care are bindingly defined by the Federal Joint Committee (G-BA) according to the Maternity Guidelines (MuRiLi). Despite these specifications, an evaluation of the data of 1,253 women in 2015 indicates an overuse of services during pregnancy, especially in the diagnostic procedures. According to MuRiLi, cardiotocographic examinations (CTG) and more than 3 ultrasound scans are only to be performed with medical indication. The use of ultrasound scans without medical indication is also no longer permitted by regulation as of 01 January 2021. In addition, there are numerous individual health services offered to pregnant women.

Aim/question: How does antenatal care compare today and in 2014?

Method: Retrospective observational study. Endpoints are the offer and implementation of various diagnostic procedures beyond the MuRiLi as well as the information and counselling to be provided according to the MuRiLi. Survey of first and multiple mothers whose last child is between 6 and 12 months old. Data analysis using descriptive and inferential statistics as well as subgroup analyses, e.g. low-risk/high risk pregnancy. A pregnancy is considered to be low-risk if none of the listed findings in the maternity record applied, a hospital stay was not necessary, and the due date was not exceeded by more than 3 days.

Preliminary results: 1,667 women took part in the survey – 48.5% of them (n=806) were first-time mothers. The mean age of the women was 33.5 years (SD 4.57). The mean duration of pregnancy was 39.3 weeks (SD 2.28). 90.6% (n=1,510) of the women stated Germany as their country of birth and 65.8% (n=1,095) had a school education on baccalaureate level. 19.9% (n=332) of the pregnancies were considered as low-risk by definition. 97.2% of the women with a low-risk pregnancy had at least one CTG during pregnancy. 271 of these women provided information on the specific number of CTG checks, reporting an average of 5 checks. 77.1% (n=215) of the women with a low-risk pregnancy who gave information on the number of ultrasound scans had received more than 3, on average 6.2 ultrasound scans. Further results, e.g. on the offer of antenatal acupuncture and craniosacral therapy, on the extent of counselling as well as the comparison with the data from 2014 will be presented in the lecture.

Relevance: In the interest of sustainability, overprovision in pregnancy should be avoided not only due to the increased consumption of resources associated with it, but also regarding to the sustainable health of mother and child. An evaluation of the extent to which care in pregnancy conforms to the guidelines is therefore crucial.

Conclusion: The preliminary results already show indications of overuse in pregnancy for certain diagnostic procedures. The further evaluation of the data will show to what extent this is also confirmed with extended evaluation strategies and contents.

Ethics and conflicts of interest: 10,000 questionnaires were sent out by BARMER to its policy holders. The legal basis of the survey is § 284 SGB V, paragraph 3 (with reference to paragraph 1) with the points 13 “Quality review” and 19 “Preparation of care innovation, information of the insured and submission of offers according to § 68B paragraph 1 and 2”. The questionnaires were returned by means of an enclosed stamped envelope. Participants were expressly requested to refrain from providing personal details on the envelope or the returned questionnaire. The questionnaires were then returned anonymously to an independent institute, which was responsible for entering and transmitting the data to the Institute of Midwifery Science, which analyzed the data. A completely anonymized data set was sent to this institute in encrypted form. On this basis, it was not necessary to obtain an ethics vote. The research was financed by own resources. There are no conflicts of interest.