WHO recommendations on antenatal care for a positive pregnancy experience

a list of ANC outcomes was prioritized for the whole
ANC period. However, due to important differences
between the types of interventions and the range of
potential outcomes, these outcomes were further
prioritized separately for individual questions.
Informed by the qualitative review of women’s views,
including values and preferences related to ANC, we
included assessment of maternal satisfaction with
a particular intervention, and maternal rating of the
usefulness of a particular intervention.
Throughout the scoping process, the Steering Group
consulted and engaged with other <strong>WHO</strong> departments
that have issued guidelines with implications for the
antenatal period, incorporating their feedback and
technical expertise into the scoping. The process
and approach were also presented at a number of
meetings and international conferences between
April 2014 and March 2015 to elicit further feedback
from stakeholders.
This scoping and consultation process led to the
identification of priority questions and outcomes
related to the effectiveness of clinical, test accuracy,
and health systems interventions aimed at achieving
a positive pregnancy experience that includes a
healthy mother and a healthy baby. These questions
and outcomes are listed in Web annex 1.
the guideline user is referred to the relevant separate
<strong>WHO</strong> guidance via a weblink provided along with the
“remarks” following each recommendation.
2.8 Focus and approach
To capture and examine the complex nature of the
issues that are important during the ANC period,
within the context of health systems and the
continuum of care, the focus of this guideline is the
essential core package of ANC that all pregnant
women and adolescent girls should receive, with the
flexibility to employ a variety of options based on
the context of different countries (i.e. in terms of the
content of the model, who provides the care, where
the care is provided, and how the care is provided to
meet women’s needs). Therefore, the overarching
questions addressed by this guideline focused on the
following:
• nWhat are the evidence-based practices during the
ANC period for improving outcomes related to the
following?
––
nutritional interventions (see section 3.A)
––
maternal and fetal assessment (see section 3.B)
––
preventive measures (see section 3.C)
––
interventions for common physiological
symptoms (see section 3.D)
<strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience
2.7 ANC-related <strong>recommendations</strong> in other
<strong>WHO</strong> guidelines
To avoid duplication and ensure harmonization of
<strong>recommendations</strong> across <strong>WHO</strong> departments and
publications, we searched all relevant <strong>WHO</strong> GRCapproved
guidelines and identified 21 guidelines
containing <strong>recommendations</strong> relevant to ANC (see
Annex 2). These <strong>recommendations</strong> were mapped
to the priority questions for this new guideline
and the Steering Group reached out to the <strong>WHO</strong>
departments and technical units that had issued the
relevant guidance to engage and collaborate with
them throughout the process of developing this new
ANC guideline. Recommendations found in other
<strong>WHO</strong> guidelines that related to health promotion
and the identification of risk factors (e.g. smoking,
HIV) during ANC were considered to be within the
scope of the guideline, whereas <strong>recommendations</strong>
on management and treatment of risk factors,
complications and concurrent diseases were deemed
to be beyond the scope of the guideline; for these,
• nHow should these evidence-based practices be
delivered to improve outcomes?
––
health systems interventions to improve the
utilization and quality of ANC (see section 3.E).
The guideline focuses on the core ANC clinical
package that all women should receive at routine
ANC visits. The management of identified
complications or concurrent diseases or risk factors
that require additional treatment or specialist care
and follow-up is beyond the scope of this guideline.
The DECIDE framework is a tool that has been
developed to help decision-makers consider a range
of relevant criteria, including benefits, harms, values,
resources, equity, acceptability and feasibility (17). To
synthesize and examine evidence across the domains
of DECIDE (see section 2.11), the preparatory work for
the ANC guideline was organized according to five
work streams, using both quantitative and qualitative
data sources, as summarized in Box 2.
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