From the Guidelines
During pregnancy, routine screening is not typically performed for most illnesses, including viral infections, mental health conditions, autoimmune disorders, cancers, neurological conditions, and gastrointestinal disorders, unless specific risk factors or symptoms are present. This approach is based on the principle of minimizing unnecessary testing and interventions that could cause anxiety or have limited benefits during pregnancy, as seen in the management of liver diseases in pregnancy 1.
Some of the illnesses that are not routinely screened for during pregnancy include:
- Viral infections like the common cold, influenza, and COVID-19, which are only tested for when symptoms appear
- Mental health conditions such as anxiety disorders, personality disorders, and PTSD, although depression screening is becoming more common
- Autoimmune disorders like rheumatoid arthritis, lupus, and multiple sclerosis, unless there's a family history or symptoms
- Most cancers, including breast, lung, colorectal, and skin cancers, which don't have pregnancy-specific screening protocols
- Neurological conditions like migraines, epilepsy, and Parkinson's disease, which are only addressed if symptoms develop
- Gastrointestinal disorders such as irritable bowel syndrome, Crohn's disease, and ulcerative colitis, which are not routinely screened for either
The approach to screening during pregnancy is guided by the need to balance the identification of concerning conditions with the avoidance of unnecessary testing and interventions, as recommended by guidelines for the management of liver diseases in pregnancy 1. This is also reflected in the screening for gestational diabetes mellitus, where screening is recommended after 24 weeks of gestation, unless there are high-risk factors present 1.
In general, the decision to screen for a particular illness during pregnancy is based on the presence of specific risk factors, symptoms, or a relevant medical or family history, and is guided by the principles of minimizing harm and maximizing benefit for both the mother and the fetus, as seen in the guidelines for the management of liver diseases in pregnancy 1.
From the Research
Illnesses Not Screened for During Pregnancy
- Toxoplasmosis is not routinely screened for in pregnant women at low risk, as stated by the Society of Obstetricians and Gynaecologists of Canada 2
- Rubella screening may not be necessary for all pregnant women, as the epidemiology of the infection is changing, and a review of this practice is needed 3
- Gastrointestinal diseases such as heartburn, nausea and vomiting, or constipation are common during pregnancy, but are not typically screened for 4
- Autoimmune diseases such as Systemic Lupus Erythematosus or Antiphospholipid Syndrome require careful management during pregnancy, but are not universally screened for 5
- Certain pregnancy complications such as gestational hypertension, pre-eclampsia, gestational diabetes, placental abruption, spontaneous preterm birth, stillbirth, and miscarriage are associated with increased risk of chronic disease in later life, but are not typically screened for in the general population 6
Selective Screening
- Selective screening for toxoplasmosis is recommended for pregnant women considered to be at risk for primary Toxoplasma gondii infection 2
- Selective screening for CMV is advocated for, but the specifics of who should be screened are not clearly defined 3
- Women with certain risk factors, such as antiphospholipid antibodies or anti-Ro/SSA antibodies, require careful management by both rheumatologists and obstetricians 5