WHO recommendations on antenatal care for a positive pregnancy experience

the completed DOI form. The responsible technical
officer collated and reviewed signed DOI forms and
curriculum vitae, in conjunction with the director of
the <strong>WHO</strong> Department of RHR and, with input from
the Steering Group, determined whether a conflict of
interest existed. Where any conflict of interest was
declared, the Steering Group determined whether it
was serious enough to affect the individual’s ability
to make objective judgements about the evidence
or <strong>recommendations</strong>. To ensure consistency, the
Steering Group applied the criteria for assessing the
severity of a conflict of interest in the <strong>WHO</strong> handbook
for guideline development (14).
All findings from the received DOI statements
were managed in accordance with the <strong>WHO</strong> DOI
guidelines on a case-by-case basis. Where a conflict
of interest was not considered significant enough to
pose any risk to the guideline development process
or reduce its credibility, the expert was only required
to declare such conflict at the GDG meeting and no
further action was taken. Conflicts of interest that
warranted action by <strong>WHO</strong> staff arose where experts
had performed primary research or a systematic
review related to any guideline <strong>recommendations</strong>;
in such cases, the experts were restricted from
participating in discussions and/or formulating any
recommendation related to the area of their conflict
of interest. At the final GDG meeting, members
were required again to state any conflicts of interest
openly to the entire group, and were required to
submit a signed and updated version of their earlier
DOI statements. A summary of the DOI statements
and information on how conflicts of interest were
managed are included in Annex 3.
2.14 Document preparation and peer
review
Following these three GDG meetings, members of the
Steering Group prepared a draft of the full guideline
document with revisions to accurately reflect the
deliberations and decisions of the GDG participants.
This draft guideline was then sent electronically to
the GDG participants for further comments before
it was sent to the ERG. The Steering Group carefully
evaluated the input of the peer reviewers for inclusion
in the guideline document and made revisions to the
guideline draft as needed. After the GDG meetings
and peer review process, further modifications to
the guideline by the Steering Group were limited to
corrections of factual errors and improvements in
language to address any lack of clarity. The revised
final version was returned electronically to the GDG
for final approval.
2.15 Presentation of guideline content
A summary of the <strong>recommendations</strong> is presented in
Table 1 within the executive summary at the beginning
of this guideline. As evidence was evaluated for
several outcomes and six domains (effects, values,
resources, equity, acceptability, feasibility) for
each recommendation, we have not presented the
decisions on quality of evidence in this summary
table. Summary tables of the main considerations
(including certainty of the evidence on effects) for
each recommendation are presented in Web annex 3.
The “Evidence and <strong>recommendations</strong>” section of
the guideline (Chapter 3) summarizes the evidence
and other considerations reviewed by the GDG at
the Technical Consultations. To improve readability,
the “values” domain has been described (and
highlighted in a box entitled “Women’s values”) at
the beginning of each section for the five types of
interventions, instead of for each recommendation,
to avoid repetition. The language used to interpret
the Cochrane review evidence on effects is consistent
with the EPOC approach (30). Evidence assessed as
being of very low certainty is not presented in the
text, but can be found in the Web supplement.
The Steering Group consolidated <strong>recommendations</strong>
into this guideline from other recent, GRC-approved
<strong>WHO</strong> guidelines relevant to the provision of
comprehensive, integrated routine ANC to women
in certain contexts or for certain conditions. In most
instances, these <strong>recommendations</strong> are identical
to those found in the specific separate guideline.
Where we have integrated <strong>recommendations</strong>,
the strength of the recommendation and quality
of the evidence as determined by the respective
GDGs for those guidelines has been recorded in
the remarks section of the recommendation. Such
<strong>recommendations</strong> are indicated by a footnote
in the ANC guideline text specifying that the
recommendation has been “integrated from” the
specific guideline. A few <strong>recommendations</strong> required
adaptation for the purposes of the ANC guideline,
and the Steering Group consulted the relevant <strong>WHO</strong>
departments that produced the specific guidance
to confirm that adaptations were consistent with
original <strong>recommendations</strong>. Such <strong>recommendations</strong>
Chapter 2. Methods
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