Obstetrics

Introduction The Living Evidence for Australian Pregnancy and Postnatal Care (LEAPP) program was established in 2023 to update and transition the Australian Pregnancy Care Guidelines into living guidelines and to establish new, living Australian Postnatal Care Guidelines. The program is a collaboration of the Australian Living Evidence Collaboration (ALEC), the Australian College of Midwives, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and 23 other Australian health organisations. The guidelines are developed using methods designed to meet the National Health and Medical Research Council standards. Clinical questions are prioritised by clinician and lived experience input. For each prioritised question, evidence is reviewed using systematic methods (existing published reviews or conducted de novo), contextual factors such as feasibility and equity are considered and new or updated recommendations are drafted. A lived experience panel and multidisciplinary clinical panels review draft recommendations. Unanimous endorsement by all 25 partner organisations is required before publication. Surveillance searches are conducted for most topic areas every 6 months. New and updated content is progressively added to the published guidelines.RecommendationsAs of August 2026 (version 11), the Australian Pregnancy Care Guidelines include 277 recommendations on more than 80 topics; 229 are new or updated since 2023. The new Australian Postnatal Care Guidelines include 149 recommendations on more than 20 topics. The guidelines are published online at https://livingevidence.org.au/living-guidelines/leapp/.Changes in Management as a Result of the GuidelineNew or updated recommendations include continuity of care, assessment and support on vaping, increased testing for syphilis, reduced testing for proteinuria, guidance on progesterone and cervical cerclage to prevent preterm birth, bereavement support, assessment and support for psychological birth trauma, screening for family violence, side sleeping in later pregnancy and a recommendation against vitamin D.

Miranda S. Cumpston, Anneliese Arno, Shaira N. Baptista, Shannon Barnes, Zoe Bradfield, Samantha P. Chakraborty, Caroline S. E. Homer, Stefan C. Kane, Nisha Khot, Steve McDonald, Steven McGloughlin, Tanya Millard, Jeremy J. N. Oats, Loyal Pattuwage, Matthew Quigley, Abdulbasit Seid, Rachel Silk, Alecia Staines, Anneliese Synnot, Alison Teate, Heath White, Tari Turner,

Australia's newborn bloodspot screening (NBS) program is offered to every newborn. It screens for 34 rare conditions with the potential for hundreds more to be added using genomics. Despite NBS being available in Australia since the 1960s, there is a lack of evidence regarding the participation and experiences of Aboriginal and Torres Strait Islander peoples in NBS. As Australia considers a future where genomics might be used in NBS, there is a critical window of opportunity to understand and prioritise the perspectives, hopes and fears of Aboriginal and Torres Strait Islander peoples regarding the utility of genomics in NBS.

Gail Garvey, Sarah Norris, Joanne Scarfe, Louise Lyons

Introduction The Australian Guidelines for the Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder were released in May 2025. These guidelines, updated from the 2016 Australian Guide, were developed through extensive stakeholder consultation, a comprehensive review of empirical evidence and the application of a novel Grading of Recommendations, Development and Evaluation (GRADE)-based approach for developing evidence-based diagnostic criteria. Recommendations The guidelines include 11 GRADE-based recommendations, forming the core of the diagnostic criteria, and 11 lived experience statements, supporting client-centred assessment approaches. The guidelines also feature 40 good practice statements and 18 implementation considerations, tools and tips as practical resources and supports for practitioners. Changes in Management as a Result of the Guidelines Key changes in the new guidelines include: A minimum prenatal alcohol exposure threshold for diagnosis to support more precise identification of fetal alcohol spectrum disorder (FASD); The assessment of neurodevelopmental impairments and functioning has been refined, including detailed advice for practitioners seeking to identify clinically significant impairments; Inclusion/exclusion of neurodevelopmental domains as part of the assessment; and Revisions to some of the content of the included neurodevelopmental domains. Changes have also been made with attention to the needs of First Nations Australians and people from other culturally and linguistically diverse backgrounds. The guidelines advocate for the use of shared decision-making approaches, promoting collaboration between practitioners, individuals attending for assessment and their support network. Importantly, the guidelines will enable an accessible, holistic and flexible assessment process, supporting timely and accurate assessment and diagnosis of FASD in Australia. The rigorous development process also provides practitioners with confidence in the guidelines, promoting increased uptake of assessment and diagnostic practices, and informing international diagnostic criteria and guidelines.

Natasha Reid · Nicole Hewlett, Nicole Hayes, Zachary Munn, Haydn Till, Delyse Hutchinson · James Stewart, Max Naglazas, Andrea Crawford, Raewyn C. Mutch, Carmela F. Pestell, Rowena Friend, Lisa K. Akison · Chelsea Vanderpeet, Prue Walker, Matthew Gullo, Doug Shelton, Elizabeth J. Elliott, Fiona Kay, Katrina Harris, Jayden Logan, Storm Anderson · Natalie R. Kippin, Seema Padencheri, Sophie Harrington, Diana Barnett, Kelly Skorka, Robyn Doney · Philippa Middleton

Maternal death is low and decreasing in Australia, but continuing surveillance is important

Michael D Humphrey