WHO recommendations on antenatal care for a positive pregnancy experience

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<strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience Type of intervention Recommendation Type of recommendation Eight scheduled ANC contacts (weeks of gestation) 1 2 3 4 5 6 7 8 (12 weeks) (20 weeks) (26 weeks) (30 weeks) (34 weeks) (36 weeks) (38 weeks) (40 weeks) Vitamin E and C supplements A.8: Vitamin E and C supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes. Not recommended Vitamin D supplements A.9: Vitamin D supplementation is not recommended for pregnant Not recommended women to improve maternal and perinatal outcomes. j Restricting caffeine intake A.10.1: For pregnant women with high daily caffeine intake (more than 300 mg per day), k lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and low-birthweight neonates. Context-specific recommendation X X X X X X X X B. Maternal and fetal assessment l Anaemia B.1.1: Full blood count testing is the recommended method for diagnosing anaemia in pregnancy. In settings where full blood count testing is not available, on-site haemoglobin testing with a haemoglobinometer is recommended over the use of the haemoglobin colour scale as the method for diagnosing anaemia in pregnancy. Context-specific recommendation X X X Asymptomatic bacteriuria (ASB) B.1.2: Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gramstaining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy. Context-specific recommendation X X X j. This recommendation supersedes the previous recommendation found in the 2012 <strong>WHO</strong> publication Guideline: vitamin D supplementation in pregnant women (75). k. This includes any product, beverage or food containing caffeine (i.e. brewed coffee, tea, cola-type soft drinks, caffeinated energy drinks, chocolate, caffeine tablets). l. Evidence on essential ANC activities, such as measuring maternal blood pressure, proteinuria and weight, and checking for fetal heart sounds, was not assessed by the GDG as these activities are considered to be part of good clinical practice. 110
Type of intervention Recommendation Type of recommendation Eight scheduled ANC contacts (weeks of gestation) 1 2 3 4 5 6 7 8 (12 weeks) (20 weeks) (26 weeks) (30 weeks) (34 weeks) (36 weeks) (38 weeks) (40 weeks) Intimate partner violence (IPV) B.1.3: Clinical enquiry about the possibility of intimate partner Context-specific violence (IPV) should be strongly considered at antenatal care visits recommendation when assessing conditions that may be caused or complicated by IPV in order to improve clinical diagnosis and subsequent care, where there is the capacity to provide a supportive response (including referral where appropriate) and where the <strong>WHO</strong> minimum requirements are met. m n X X X X X X X X Gestational diabetes mellitus (GDM) B.1.4: Hyperglycaemia first detected at any time during pregnancy should be classified as either, gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy, according to <strong>WHO</strong> 2013 criteria. o Recommended X X X X X X X X Tobacco use B.1.5: Health-care providers should ask all pregnant women about Recommended X X X X X X X X their tobacco use (past and present) and exposure to second-hand smoke as early as possible in the pregnancy and at every antenatal Substance use B.1.6: Health-care providers should ask all pregnant women about their use of alcohol and other substances (past and present) as early as possible in the pregnancy and at every antenatal care visit. q Recommended X X X X X X X X m. Minimum requirements are: a protocol/standard operating procedure; training on how to ask about IPV, and on how to provide the minimum response or beyond; private setting; confidentiality ensured; system for referral in place; and time to allow for appropriate disclosure. n. This recommendation is consistent with the 2013 publication Responding to intimate partner violence and sexual violence against women: <strong>WHO</strong> clinical and policy guidelines (86). o. This is not a recommendation on routine screening for hyperglycaemia in pregnancy. It has been adapted and integrated from the 2013 <strong>WHO</strong> publication Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy (94), which states that GDM should be diagnosed at any time in pregnancy if one or more of the following criteria are met: • fasting plasma glucose 5.1–6.9 mmol/L (92–125 mg/dL) • 1-hour plasma glucose 10.0 mmol/L (180 mg/dL) following a 75 g oral glucose load • 2-hour plasma glucose 8.5–11.0 mmol/L (153–199 mg/dL) following a 75 g oral glucose load. Diabetes mellitus in pregnancy should be diagnosed if one or more of the following criteria are met: • fasting plasma glucose 7.0 mmol/L (126 mg/dL) • 2-hour plasma glucose 11.1 mmol/L (200 mg/dL) following a 75 g oral glucose load • random plasma glucose 11.1 mmol/L (200 mg/dL) in the presence of diabetes symptoms. p. Integrated from the 2013 publication <strong>WHO</strong> <strong>recommendations</strong> for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy (96). q. Integrated from the 2014 <strong>WHO</strong> publication Guidelines for the identification and management of substance use and substance use disorders in pregnancy (97). Chapter 4. Implementation of the ANC guideline and <strong>recommendations</strong> 111
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Funding was provided for this guide
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Evaluation (GRADE) and Confidence i
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Zinc supplements Multiple micronutr
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Ultrasound scan Doppler ultrasound
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Task shifting components of antenat
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expect from ANC is to have a “pos
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2. Methods WHO <st
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a list of ANC outcomes was prioriti
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content experts among the GDG membe
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• nFeasibility: Feasibility is in
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A. Nutritional interventions <stron
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A.1.2: Nutrition education on energ
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A.1.3: Energy and protein dietary s
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A.1.4: High-protein supplements REC
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Summary of evidence and considerati
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Equity Effective interventions to i
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A.7: Vitamin B6 (pyridoxine) supple
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only a quarter of the planned sampl
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A.10: Restricting caffeine intake R
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B. Maternal and fetal assessment B.
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to produce results than urine dipst
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B.1.4: Gestational diabetes mellitu
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B.1.6: Substance use RECOMMENDATION
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on screening, please refer to the 2
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Women’s values A scoping review o
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B.2.2: Symphysis-fundal height (SFH
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B.2.4: Ultrasound scan RECOMMENDATI
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WHO recommendations on antenatal care for a positive pregnancy experience

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