WHO recommendations on antenatal care for a positive pregnancy experience

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<strong>WHO</strong> Library Cataloguing-in-Publication Data <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience. I.World Health Organization. ISBN 978 92 4 154991 2 Subject headings are available from <strong>WHO</strong> institutional repository © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the <strong>WHO</strong> website (http://www.who.int) or can be purchased from <strong>WHO</strong> Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: bookorders@who.int). Requests for permission to reproduce or translate <strong>WHO</strong> publications – whether for sale or for non-commercial distribution – should be addressed to <strong>WHO</strong> Press through the <strong>WHO</strong> website (http://www.who.int/about/licensing/copyright_form). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Editing, design and layout by Green Ink, United Kingdom (www.greenink.co.uk)
Contents Acknowledgements Acronyms and abbreviations Executive summary 1. Introduction 1 2. Methods 4 3. Evidence and <strong>recommendations</strong> 13 A. Nutritional interventions 14 B. Maternal and fetal assessment 40 C. Preventive measures 63 D. Interventions for common physiological symptoms 74 E. Health systems interventions to improve the utilization and quality of ANC 85 4. Implementation of the ANC guideline and <strong>recommendations</strong>: introducing the 2016 <strong>WHO</strong> ANC model 105 5. Research implications 118 6. Dissemination, applicability and updating of the guideline and <strong>recommendations</strong> 120 References 123 Annex 1: External experts and <strong>WHO</strong> staff involved in the preparation of this guideline 137 Annex 2: Other <strong>WHO</strong> guidelines with <strong>recommendations</strong> relevant to routine ANC 141 Annex 3: Summary of declarations of interest from the Guideline Development Group (GDG) members and how they were managed 143 Annex 4: Implementation considerations for ANC guideline <strong>recommendations</strong> 145 v vii ix Web annexes: <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience* Web annex 1: Priority questions and outcomes for the antenatal care (ANC) interventions identified for this guideline Web annex 2: Changes from the approved scope of this guideline Web annex 3: Guideline Development Group (GDG) judgements related to the <strong>recommendations</strong> Web supplement: <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience: evidence base* The standardized criteria used in grading the evidence and the GRADE tables have been published in this separate Web supplement. These evidence tables are referred to within this document by number, prefixed with "EB" (for evidence base), for ease of reference. * available at: www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/
Page 1: WHO recomm
Page 6 and 7: « To achieve the Every Woman Every
Page 8 and 9: Funding was provided for this guide
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Page 12 and 13: Evaluation (GRADE) and Confidence i
Page 14 and 15: Zinc supplements Multiple micronutr
Page 16 and 17: Ultrasound scan Doppler ultrasound
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Page 28 and 29: • nFeasibility: Feasibility is in
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Page 44 and 45: Summary of evidence and considerati
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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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may help to address inequalities. H
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E.6: Recruitment and retention of s
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visits (high confidence in the evid
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5. Research implications During the
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6. Dissemination, applicability and
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espectively. Any concern about the
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105. Systematic screening for activ
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WHO headquarters (
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Dr Erika Ota Nutrition, evidence sy
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