Guideline

WHO recommendations on antenatal care for a positive pregnancy experience

Year of Publication

2016

Issuing Institution

WHO

Links

WHO IRIS,Google Scholar

Recommendations

48 included recommendations

Full blood count testing is the recommended method for diagnosing anaemia during pregnancy. Where fully blood count testing is not available, onsite haemoglobin testing with a hamoglobinometer is recommended over the haemoglobin colour scale method as the method for detecting anaemia.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

For pregnant women with high daily caffeine intake (more than 300 mg per day), lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and low birth weight neonates.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

In malaria-endemic areas in Africa, intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for all pregnant women. Dosing should start in the second trimester, and doses should be given at least one month apart, with the objective of ensuring that at least three doses are received.

Status

Retired

Context specific recommendation

Only in specific contexts

Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental irona and 400 µg (0.4 mg) folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth

Status

Maintained

Recommended

Intermittent oral iron and folic acid supplementation with 120 mg of elemental ironc and 2800 µg (2.8 mg) folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes if daily iron is not acceptable due to side-effects, and in populations with an anaemia prevalence among pregnant women of less than 20%.

Status

Maintained

Context specific recommendation

Only in specific contexts

In undernourished populations, balanced energy and protein dietary supplementation is recommended for pregnant women to reduce the risk of stillbirths and small for- gestational-age neonates.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

In undernourished populations, high-protein supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes

Status

Maintained

Not recommended

Certainty of evidence

High

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.

Status

Maintained

Recommended

Vitamin A supplementation is only recommended for pregnant women in areas where vitamin A deficiency is a severe public health problem, to prevent night blindness.

Status

Maintained

Context specific recommendation

Only in specific contexts

Vitamin E and C supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.

Status

Maintained

Not recommended

Zinc supplementation for pregnant women is only recommended in the context of rigorous research.

Status

Retired

Recommendation in research context

Only in research contexts

Ginger, chamomile, vitamin B6 and/or acupuncture are recommended for the relief of nausea in early pregnancy, based on a woman’s preferences and available options.

Status

Maintained

Recommended

Advice on diet and lifestyle is recommended to prevent and relieve heartburn in pregnancy. Antacid preparations can be offered to women with troublesome symptoms that are not relieved by lifestyle modification.

Status

Maintained

Recommended

Vitamin D supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes

Status

Updated

Not recommended

Multiple micronutrient supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes

Status

Retired

Not recommended

Magnesium, calcium or non-pharmacological treatment options can be used for the relief of leg cramps in pregnancy, based on a woman’s preferences and available options.

Status

Maintained

Recommended

Regular exercise throughout pregnancy is recommended to prevent low back and pelvic pain. There are a number of different treatment options that can be used, such as physiotherapy, support belts and acupuncture, based on a woman’s preferences and available options.

Status

Maintained

Recommended

Wheat bran or other fibre supplements can be used to relieve constipation in pregnancy if the condition fails to respond to dietary modification, based on a woman’s preferences and available options.

Status

Maintained

Recommended

Non-pharmacological options, such as compression stockings, leg elevation and water immersion, can be used for the management of varicose veins and oedema in pregnancy based on a woman’s preferences and available options.

Status

Maintained

Recommended

In undernourished populations, nutrition education on increasing daily energy and protein intake is recommended for pregnant women to reduce the risk of low birth- weight neonates

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gram-staining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy

Status

New

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

Clinical enquiry about the possibility of intimate partner violence (IPV) should be strongly considered at antenatal care visits when assessing conditions that may be caused or complicated by IPV in order to improve clinical diagnosis and subsequent care, where there is the capacity to provide a supportive response (including referral where appropriate) and where the WHO minimum requirements are met

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Low

Hyperglycaemia first detected at any time during pregnancy should be classified as either gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy, according to WHO criteria

Status

New

Recommended

Health-care providers should ask all pregnant women about their use of alcohol and other substances (past and present) as early as possible in the pregnancy and at every antenatal care visit

Status

New

Recommended

Certainty of evidence

Low

In settings where the tuberculosis (TB) prevalence in the general population is 100/100 000 population or higher, systematic screening for active TB should be considered for pregnant women as part of antenatal care.

Status

New

Context specific recommendation

Only in specific contexts

Daily fetal movement counting, such as with “count-to-ten” kick charts, is only recommended in the context of rigorous research

Status

New

Recommendation in research context

Only in research contexts

Replacing abdominal palpation with symphysis-fundal height (SFH) measurement for the assessment of fetal growth is not recommended to improve perinatal outcomes. A change from what is usually practiced (abdominal palpation or SFH measurement) in a particular setting is not recommended.

Status

New

Context specific recommendation

Only in specific contexts

Certainty of evidence

Very low

Routine antenatal cardiotocography is not recommended for pregnant women to improve maternal and perinatal outcomes

Status

New

Not recommended

Certainty of evidence

Very low

One ultrasound scan before 24 weeks of gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience

Status

Retired

Recommended

Certainty of evidence

Low

Routine Doppler ultrasound examination is not recommended for pregnant women to improve maternal and perinatal outcomes.

Status

New

Not recommended

Certainty of evidence

Low

A seven-day antibiotic regimen is recommended for all pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth and low birth weight.

Status

New

Recommended

Antibiotic prophylaxis is only recommended to prevent recurrent urinary tract infections in pregnant women in the context of rigorous research

Status

New

Recommendation in research context

Only in research contexts

Certainty of evidence

Very low

Antenatal prophylaxis with anti-D immunoglobulin in non-sensitized Rh-negative pregnant women at 28 and 34 weeks of gestation to prevent RhD alloimmunization is recommended only in the context of rigorous research. (Context-specific recommendation – research)

Status

New

Recommendation in research context

Only in research contexts

Certainty of evidence

Very low

Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus.

Status

New

Recommended

Oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) should be offered as an additional prevention choice for pregnant women at substantial risk of HIV infection as part of combination prevention approaches

Status

New

Context specific recommendation

Only in specific contexts

It is recommended that each pregnant woman carries her own case notes during pregnancy to improve continuity, quality of care and her pregnancy experience.

Status

Maintained

Recommended

Certainty of evidence

Moderate

Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well functioning midwifery programmes.

Status

Maintained

Context specific recommendation

Only in specific contexts

Group antenatal care provided by qualified health-care professionals may be offered as an alternative to individual antenatal care for pregnant women in the context of rigorous research, depending on a woman’s preferences and provided that the infrastructure and resources for delivery of group antenatal care are available

Status

New

Recommendation in research context

Only in research contexts

Certainty of evidence

Low

The implementation of community mobilization through facilitated participatory learning and action (PLA) cycles with women’s groups is recommended to improve maternal and newborn health, particularly in rural settings with low access to health services. Participatory women’s groups represent an opportunity for women to discuss their needs during pregnancy, including barriers to reaching care, and to increase support to pregnant women.

Status

New

Context specific recommendation

Only in specific contexts

Certainty of evidence

Low

Packages of interventions that include household and community mobilization and antenatal home visits are recommended to improve antenatal care utilization and perinatal health outcomes, particularly in rural settings with low access to health services

Status

Updated

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

Task shifting the promotion of health-related behaviours for maternal and newborn health to a broad range of cadres, including lay health workers, auxiliary nurses, nurses, midwives and doctors is recommended

Status

New

Recommended

Task shifting the distribution of recommended nutritional supplements and intermittent preventive treatment in pregnancy (IPTp) for malaria prevention to a broad range of cadres, including auxiliary nurses, nurses, midwives and doctors is recommended

Status

New

Recommended

Policy-makers should consider educational, regulatory, financial, and personal and professional support interventions to recruit and retain qualified health workers in rural and remote areas

Status

New

Context specific recommendation

Only in specific contexts

Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care

Status

New

Recommended

Vitamin B6 (pyridoxine) supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.

Status

Maintained

Not recommended

Health-care providers should ask all pregnant women about their tobacco use (past and present) and exposure to second-hand smoke as early as possible in pregnancy and at every antenatal care visit.

Status

Maintained

Recommended

In populations with low dietary calcium intake, daily calcium supplementation (1.5–2.0 g oral elemental calcium) is recommended for pregnant women to reduce the risk of pre-eclampsia

Status

Retired

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

In endemic areas (greater than 20% prevalence of infection with any soil-transmitted helminths) a preventive anthelminthic treatment is recommended for pregnant women after the first trimester as part of worm infection reduction programmes

Status

Maintained

Context specific recommendation

Only in specific contexts