WHO recommendations on antenatal care for a positive pregnancy experience

Women’s values
A scoping review of what women want from ANC and what outcomes they value informed the ANC guideline (13).
Evidence showed that women from high-, medium- and low-resource settings valued having a positive pregnancy
experience, the components of which included the provision of effective clinical practices (interventions and tests,
including nutritional supplements), relevant and timely information (including dietary and nutritional advice) and
psychosocial and emotional support, by knowledgeable, supportive and respectful health-care practitioners, to
optimize maternal and newborn health (high confidence in the evidence).
A.1: Dietary interventions
A1.1: Counselling on healthy eating and physical activity
RECOMMENDATION A.1.1: Counselling about healthy eating and keeping physically active
during pregnancy is recommended for pregnant women to stay healthy and to prevent excessive
weight gain during pregnancy. (Recommended)
Remarks
• A healthy diet contains adequate energy, protein, vitamins and minerals, obtained through the
consumption of a variety of foods, including green and orange vegetables, meat, fish, beans, nuts, whole
grains and fruit (41).
• Stakeholders may wish to consider culturally appropriate healthy eating and exercise interventions
to prevent excessive weight gain in pregnancy, particularly for populations with a high prevalence of
overweight and obesity, depending on resources and women’s preferences. Interventions should be
woman-centred and delivered in a non-judgemental manner, and developed to ensure appropriate weight
gain (see further information in points below).
• A healthy lifestyle includes aerobic physical activity and strength-conditioning exercise aimed at
maintaining a good level of fitness throughout pregnancy, without trying to reach peak fitness level or
train for athletic competition. Women should choose activities with minimal risk of loss of balance and
fetal trauma (42).
• Most normal gestational weight gain occurs after 20 weeks of gestation and the definition of “normal” is
subject to regional variations, but should take into consideration pre-pregnant body mass index (BMI).
According to the Institute of Medicine classification (43), women who are underweight at the start of
pregnancy (i.e. BMI < 18.5 kg/m 2 ) should aim to gain 12.5–18 kg, women who are normal weight at the
start of pregnancy (i.e. BMI 18.5–24.9 kg/m 2 ) should aim to gain 11.5–16 kg, overweight women (i.e. BMI
25–29.9 kg/m 2 ) should aim to gain 7–11.5 kg, and obese women(i.e. BMI > 30 kg/m 2 ) should aim to gain
5–9 kg.
• Most evidence on healthy eating and exercise interventions comes from high-income countries (HICs),
and the GDG noted that that there are at least 40 ongoing trials in HICs in this field. The GDG noted that
research is needed on the effects, feasibility and acceptability of healthy eating and exercise interventions
in LMICs.
• Pregnancy may be an optimal time for behaviour change interventions among populations with a high
prevalence of overweight and obesity, and the longer-term impact of these interventions on women,
children and partners needs investigation.
• The GDG noted that a strong training package is needed for practitioners, including standardized
guidance on nutrition. This guidance should be evidence-based, sustainable, reproducible, accessible and
adaptable to different cultural settings.
Chapter 3. Evidence and <strong>recommendations</strong> 15