New WHO antenatal care model—quality worth paying for?

Abstract

The 2016 WHO guidelines on antenatal care 1 were published earlier this month and are widely welcomed because they are not only academically robust, but also relevant to end-users and patients. The guidelines cover antenatal care for normal pregnancies and have adopted a woman-centred, holistic approach to care. They cover nutritional interventions, maternal and fetal assessment, preventive measures, interventions for common physiological pregnancy symptoms, and health systems interventions to improve the use and quality of antenatal care. The guidelines address antenatal evidence-based practices that improve outcomes and detail how these practices should be delivered. In addition to standard antenatal medical advice, the 49 recommendations include guidance on psychological support, nutrition, and domestic violence screening. Each recommendation is backed up with an evidence review, generally based upon systematic reviews conducted by the Cochrane Collaboration. But even with the most rigorous analyses of the evidence, there are conflicting opinions as to how to deal with some of the results, and what to recommend when there is very limited evidence to support or reject common practice. The WHO antenatal care Guideline Development Group (GDG) is to be congratulated for putting into practice the old adage that “no evidence of benefit is not the same as evidence of no benefit”. So in symphysis-fundal height measurement, for example, where there is limited evidence for its benefit, they do not discard it but recommend that clinicians continue whatever is their current practice.