Last year, an estimated 303,000 women died from pregnancy-related causes, 2.7 million babies died during the first 28 days of life and 2.6 million babies were stillborn. Access to quality healthcare during pregnancy and childbirth may prevent many of these deaths. It is estimated only 64% of women receive prenatal care four or more times throughout their pregnancy.
These visits provide doctors with the critical opportunity to deliver care, support, and information to pregnant women. This includes promoting a healthy lifestyle, including good nutrition; detecting and preventing diseases; providing family planning counseling and supporting women who may be experiencing intimate partner violence.
“If women are to use antenatal care services and come back when it is time to have their baby, they must receive good quality care throughout their pregnancy,” says Dr Ian Askew, Director of Reproductive Health and Research, WHO. “Pregnancy should be a positive experience for all women and they should receive care that respects their dignity.”
Under their new antenatal care model, the World Health Organization recommends moms-to-be increase their visits with health providers throughout their pregnancy to eight from four. They believe the higher frequency would reduce the likelihood of stillbirths because doctors would be more in touch and could detect and manage potential problems more efficiently. Having woman visit their doctors 8 times during their pregnancy can reduce perinatal deaths by up to 8 per 1000 births when compared to a minimum of four visits.
Under this new recommendation, pregnant women are to have their first contact in the first 12 weeks’ gestation, with subsequent visits taking place at 20, 26, 30, 34, 36, 38 and 40 weeks’ gestation.
“More and better quality contacts between all women and their health providers throughout pregnancy will facilitate the uptake of preventive measures, timely detection of risks, reduces complications and addresses health inequalities,” says Dr Anthony Costello, Director of Maternal, Newborn, Child and Adolescent Health, WHO. “Antenatal care for first time mothers is key. This will determine how they use antenatal care in future pregnancies.”
The new guidelines contain 49 recommendations that outline what care pregnant women should receive at each of the contacts with the health system, including counselling on healthy diet and optimal nutrition, physical activity, tobacco and substance use; malaria and HIV prevention; blood tests and tetanus vaccination; fetal measurements including use of ultrasound; and advice for dealing with common physiological symptoms such as nausea, back pain and constipation.
“Counselling about healthy eating, optimal nutrition and what vitamins or minerals women should take during pregnancy can go a long way in helping them and their developing babies stay healthy throughout pregnancy and beyond,” says Dr Francesco Branca, Director Department on Nutrition for Health and Development, WHO.
These recommendations allow flexibility for countries to employ different options for the delivery of antenatal care based on their specific needs. Care, in some cases, can be provided through midwives or other trained health personnel, delivered at health facilities or through community outreach services.
Some of the recommendations include:
- Antenatal care model with a minimum of eight contacts recommended to reduce perinatal mortality and improve women’s experience of care.
- Counseling about healthy eating and keeping physically active during pregnancy.
- Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) folic acid for pregnant women to prevent maternal anemia, puerperal sepsis, low birth weight, and preterm birth.
- Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus.
- One ultrasound scan before 24 weeks’ gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labor for post-term pregnancy, and improve a woman’s pregnancy experience.
- 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 visit.