WHO recommendations on antenatal care for a positive pregnancy experience

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Dr Erika Ota Nutrition, evidence synthesis, guideline development None declared Not applicable Dr Kathleen Rasmussen Maternal and child nutrition None declared Not applicable Dr Niveen Abu Rmeileh Community and public health, statistical epidemiology None declared Not applicable Prof. H.P.S. Sachdev Paediatrics, nutrition, systematic reviews None declared Not applicable Ms Rusidah Selamat Maternal and infant nutrition, community-based programmes, implementation research None declared Not applicable Dr Lisa Noguchi Midwifery, delivery of care, implementation science Technical advisor to Bill & Melinda Gates Foundationfunded study on group ANC for increasing facility delivery; travel costs supplied by the Maternal and Child Survival Program. The conflict was not considered serious enough to affect GDG membership or participation in the Technical Consultation. Dr Tomas Pantoja Obstetrics and gynaecology, health systems None declared Not applicable Dr Charlotte Warren Maternal and perinatal health, systematic reviews, implementation research None declared Not applicable Prof. Charles Wisonge Health systems, systematic reviews, delivery of care None declared Not applicable <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience 144
Annex 4: Implementation considerations for ANC guideline <strong>recommendations</strong> Implementation considerations for ANC guideline <strong>recommendations</strong> Need to know Need to do Need to have Consider A. Nutritional interventions A.1.1. Nutritional counselling on a healthy diet and physical activity • Healthy diet and exercise in local context • Prevalence of overweight • Counselling • Counselling skills • Time and space for counselling • Gender issues and cultural expectations of women • Local food security A.1.2. Nutritional education on increasing daily energy and protein intake • If your setting has an undernourished population • How to do counselling • Counselling • Time to counsel • Counselling skills • Capacity-building for ANC providers on nutrition counselling • Task shifting • Group-based counselling A.1.3. Balanced energy and protein supplementation in undernourished populations • What balanced energy and protein supplementation means • What is available locally that provides this • Counselling • Time to counsel • Counselling skills • Capacity-building for ANC providers on nutrition counselling • Task shifting • Group-based counselling A.1.4 High protein supplementation in undernourished populations • If this is in use • If in use, advise against high protein supplementation during pregnancy • N/A • N/A A.2. Iron and folic acid supplements • That iron and folic acid is still recommended • Counselling • Dispensing • Time to counsel • Counselling skills • Commodities management • Timing of iron vs calcium dosing • Community-based dispensing • Task shifting • Group-based counselling A.3. Calcium supplements • If dietary calcium is low in the local population • Counselling • Dispensing • Time to counsel • Counselling skills • Commodities management • Timing of iron vs calcium dosing • Community-based dispensing • Task shifting • Group-based counselling A.4. Vitamin A supplements • If night blindness is endemic • Counselling • Dispensing • Time to counsel • Counselling skills • Commodities management • Referencing existing guideline • Community-based dispensing • Task shifting • Group-based counselling Annex 4: Implementation considerations 145
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« To achieve the Every Woman Every
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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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are indicated by a footnote in the
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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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are willing to be screened and test
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Women’s values A scoping review o
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C.4: Preventive anthelminthic treat
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C.5: Tetanus toxoid vaccination REC
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C.6: Intermittent preventive treatm
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D. Interventions for common physiol
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Values See “Women’s values” a
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D.4: Interventions for low back and
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Acceptability Qualitative evidence
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Additional considerations • nComp
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Senegal, Sri Lanka, Yemen and Zambi
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WHO recommendations on antenatal care for a positive pregnancy experience

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