1. 9789241549912-eng.pdf, page 92
D. Interventions for common
physiological symptoms
Background
WHO recommendations on antenatal care for a positive pregnancy experience
Women’s bodies undergo substantial changes
during pregnancy, which are brought about by both
hormonal and mechanical effects. These changes lead
to a variety of common symptoms – including nausea
and vomiting, low back and pelvic pain, heartburn,
varicose veins, constipation and leg cramps – that in
some women cause severe discomfort and negatively
affects their pregnancy experience. In general,
symptoms associated with mechanical effects, e.g.
pelvic pain, heartburn and varicose veins, often
worsen as pregnancy progresses.
74
with pain, night cramps, aching and heaviness,
and worsen with long periods of standing (160).
Constipation can be very troublesome and may be
complicated by haemorrhoids (161). Leg cramps often
occur at night and can be very painful, affecting sleep
and daily activities (162). Suggested approaches to
manage common physiological symptoms include a
variety of non-pharmacological and pharmacological
options and the GDG considered the evidence and
other relevant information on these approaches.
...
Symptoms of nausea and vomiting are experienced
by approximately 70% of pregnant women and
usually occur in the first trimester of pregnancy
(156); however, approximately 20% of women may
experience nausea and vomiting beyond 20 weeks of
gestation (157). Low back and pelvic pain is estimated
to occur in half of pregnant women, 8% of whom
experience severe disability (158). Symptoms of
heartburn occur in two thirds of pregnant women,
and may be worse after eating and lying down (159).
Varicose veins usually occur in the legs, but can also
occur in the vulva and rectum, and may be associated
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. This
included woman-centred advice and treatment for
common physiological symptoms (high confidence
in the evidence). In many LMICs, this also included
support and respect for women’s use of alternative
or traditional approaches to the diagnosis and
treatment of common pregnancy-related symptoms
(moderate confidence in the evidence).
2. 9789241549912-eng.pdf, page 15
B.1.4: 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.o
Recommended
Tobacco use
B.1.5: 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 the pregnancy and at every antenatal care visit.p
Recommended
Substance use
B.1.6: 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.q
Recommended
Human immunodeficiency virus
(HIV) and syphilis
B.1.7: In high-prevalence settings,r provider-initiated testing and
counselling (PITC) for HIV should be considered a routine component
of the package of care for pregnant women in all antenatal care settings.
In low-prevalence settings, PITC can be considered for pregnant women
in antenatal care settings as a key component of the effort to eliminate
mother-to-child transmission of HIV, and to integrate HIV testing
with syphilis, viral or other key tests, as relevant to the setting, and to
strengthen the underlying maternal and child health systems.s
Recommended
Tuberculosis (TB)
B.1.8: 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.t
Context-specific
recommendation
B.2: Fetal assessment
Daily fetal
movement
counting
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[2] https://storage.googleapis.com/dara-c1b52.appspot.com/daras_ai/media/3cec8500-b3ef-11ed-82e3-02420a0001f7/9789241549912-eng.pdf#page=15