Antenatal Care

Learn how antenatal care promotes the health and well-being of

women and babies before, during, and after pregnancy.

Why Antenatal Care Is Critical

Quality health care during pregnancy is essential
to the health and well-being of women and the
development of babies. All women have the right
to receive adequate care throughout pregnancy,
childbirth, and the postnatal period. Inadequate care
during this time can lead to long-term or fatal health
problems for women and babies.

Antenatal care (ANC) services support pregnant

Biro/IRC
women and families by:

• Providing integrated care throughout pregnancy

(disease prevention, screening, early detection Antenatal Care Services
and treatment)

• Encouraging pregnant women and their

families to use health services and advocating
safe motherhood practices

• Increasing the chance of using a skilled

attendant at birth to ensure a clean,
safe delivery

• Reducing complications from pregnancy

and childbirth

• Reducing stillbirths and perinatal deaths

• Promoting healthy behaviors throughout

pregnancy and motherhood (breastfeeding,
early postnatal care, and planning for optimal
pregnancy spacing)
IRC
• Helping expecting mothers plan, prepare, and
practice parenting skills
© Copyright 2019 Cornerstone OnDemand Foundation 1
Antenatal Care Model
The World Health Organization’s (WHO) Antenatal Care Model recommends that pregnant women have
a minimum of eight to ten contacts with a health care provider to:

• Review relevant and timely information about the pregnancy, including psychosocial and
emotional support

• Review plans for childbirth and postnatal and neonatal care

• Prepare for any potential complications (perform standard screenings and tests)

• Detect and treat health problems in mother and baby

The number of contacts can depend on whether the pregnancy becomes complicated and each
country’s national policies and standards.

Antenatal Care Model

First Trimester

Contact 1: Up to 12 weeks

An early ultrasound scan is recommended for

all pregnant women BEFORE 24 weeks.

Second Trimester
1 2 3

Contact 2: 20 weeks
Contact 3: 26 weeks

Third Trimester

Contact 4: 30 weeks
Contact 5: 32 weeks
Contact 6: 36 weeks
Contact 7: 38 weeks
Contact 8: 40 weeks

Return for delivery at 41 weeks if not given birth.

Based on the 2016 WHO Antenatal Care Model

© Copyright 2019 Cornerstone OnDemand Foundation 2

Antenatal Appointments
Health care providers and expecting mothers should discuss essential information during antenatal
appointments.

01. Review how the trimester is progressing and what to expect during that time, and
discuss any issues or problematic symptoms.

02. Run through the childbirth plan, due date, and emergency preparation elements such as
transportation, money, identification of blood donors, and appointment of a person to
decide on behalf of the expecting mother.

03. Identify potential risks and danger signs during pregnancy and their possible causes,
and determine when to seek help to prevent further complications.

04. Assess medical history, general health, any current medication or treatments, and
experiences from any previous pregnancies.

05. Check blood pressure and weight and test urine.

06. Feel and measure the stomach (conduct ultrasound as needed), and listen to the
baby’s heartbeat.

07. Organize blood tests, scans, and screening (including pap test).

08. Advise on the prevention of infectious diseases, including malaria and sexually
transmitted infections, and the transmission of HIV/AIDS from the mother to fetus.

09. Advise on diet, nutrition, exercise, rest, lifestyle changes, and the risks associated with
the use of alcohol, tobacco, and other substances.

© Copyright 2019 Cornerstone OnDemand Foundation 3

 10. Review hygiene and disease prevention methods (handwashing and safe disposal of
baby waste).

11. Ensure good mental health, provide support for depression or anxiety, and direct
mothers to available services if family violence is an issue.

12. Provide information about breathing exercises during delivery (when antenatal classes
are not available), taking the baby home, infant feeding and breastfeeding, and other care.

13. Discuss the benefits of birth spacing, and introduce family planning methods
after pregnancy.

© Copyright 2019 Cornerstone OnDemand Foundation 4

Health Promotion During
Pregnancy
Women will experience physiological changes
and symptoms throughout the different stages
of pregnancy.

It is important that pregnant women can identify

when symptoms are normal and when they could
be a sign of a more serious problem that requires
immediate medical attention.

Providing women with relevant and timely

information about common physiological Health Promotion
symptoms and danger signs can greatly reduce During Pregnancy
the risk of serious harm and promote a positive
pregnancy experience for women.

Kawar/IRC

© Copyright 2019 Cornerstone OnDemand Foundation 5

Common Physiological Symptoms During Pregnancy
Health Risk: Low Common Physiological Changes and
Symptoms at Different Stages of
Pregnancy
• Nausea and morning sickness

• Dizziness

• Heartburn and indigestion

• Constipation

• Urinary frequency and leaking

• Extreme fatigue and sleep problems

• Mood swings

• Headaches

• Nasal problems (nosebleeds and nasal

congestion)

• Hemorrhoids

• Itching

Temporary Relief from Common Symptoms

• Change or add certain foods, vitamins, and supplements to their diet

• Exercise

• Take nonpharmacological treatments and medications

• Receive acupuncture or massage

• Wear compression socks and

support belts

• Increase rest and sleep

© Copyright 2019 Cornerstone OnDemand Foundation 6

Medium-Risk Danger Signs During Pregnancy
Health Risk: Medium
Pregnant women should consult their health care
provider when experiencing any of the following
symptoms:

• Stomach pain or gastric pain

○ Possible causes: Preeclampsia

or acid reflux (heartburn)

• Oliguria (reduced amount of urine)

○ Possible causes: Dehydration (medium

risk), renal failure (high risk)

• Severe pain during urination

○ Possible cause: Urinary tract infection (UTI)

High-Risk Danger Signs During Pregnancy

Health Risk: High

Pregnant women should go to the hospital or seek
immediate medical attention when experiencing any
of the following symptoms:

• Convulsions

• Seizures

• Vaginal hemorrhage

• Fever over 43°C / 110°F and sudden cold

• Continuous vomiting in the last trimester

• Absence of fetal movement or loss of

quickening

© Copyright 2019 Cornerstone OnDemand Foundation 7

Preventing Disease During Pregnancy
Pregnancy can make women more susceptible to certain infections, which can lead to serious
complications, such as miscarriage, preterm labor, and birth defects. Maternal and fetal
assessment and screening is a key part of antenatal care to prevent severe infections and disease
throughout pregnancy.

Anemia Tetanus Infection

Prevention and Treatment: Prevention in communities with limited tetanus
immunization:
• Take iron and folate supplements.
• Give second dose of tetanus vaccine (T2)
• Eat iron-rich foods. between one and two weeks before birth.
• Treat and prevent malaria and hookworms. • Lifetime immunization is achieved after the
• If not treated, it can lead to heart failure. fifth dose of the vaccine.

• If not treated, can be fatal.

UTI
Prevention and Treatment: Mother-to-Child HIV Transmission
• Increase liquid intake. Prevention and Treatment in communities of
high HIV prevalence:
• Take oral antibiotics.
• Offer Provider-Initiated Testing and
• If not treated, it can lead to renal failure. Counselling (PITC).

• Provide regular monitoring of HIV medication

Hyperglycemia
side effects and HIV infection complications
Prevention: (tuberculosis, leishmaniasis).

• Exercise

• Low-sugar diet

• If not treated, can lead to gestational

diabetes mellitus, which may persist after
pregnancy as type 2 diabetes mellitus.

© Copyright 2019 Cornerstone OnDemand Foundation 8

Diet and Nutrition

A healthy, balanced diet during pregnancy provides

essential nutrients for the growth and development
of babies. Pregnant women need about 200–300
extra calories from foods rich in calcium, folic acid,
iron, and protein. Discussing healthy eating habits is
an important part of antenatal care.

Pregnancy Diet
and Nutrition

Calcium: Promotes the growth of teeth, bones, heart, and nervous

system.
Food sources: Milk, yogurt, cheese, sardines or salmon with bones, some leafy greens

Daily dose: 1,000 mg for pregnant and lactating women (1,300 mg for women 19 years
or younger)

Folic acid: Prevents birth defects in the baby’s brain and spinal cord
(neural tube defects).
Food sources: Leafy green vegetables, legumes, beans, citrus fruits, lentils, nuts

Daily dose: 400–600 mg

Iron: Maintains healthy red blood cells that supply oxygen to the baby
and prevents maternal anemia, fatigue, and infections.
Food sources: Meat, poultry, fish, dried beans and peas, green leafy vegetables

Daily dose: 27 mg (double the normal intake)

Protein: Builds baby’s muscles and important organs (the brain and
heart).
Food sources: Meat, poultry, fish, eggs, tofu, soy products, nuts, seeds, dried beans, and
peas

Daily dose: 70–100g

© Copyright 2019 Cornerstone OnDemand Foundation 9

 Sugar: Avoid excess sugar to prevent gestational diabetes, fatty liver,
and weight gain.

Salt: Reduce salt intake to avoid fluid retention and high blood pressure.

Caffeine: Limit or lower daily caffeine intake (maximum two cups of

coffee or three cups of tea) to reduce the risk of miscarriage and low
birth weight.

Alcohol: Avoid alcohol to reduce the risk of premature birth, low

birth weight, and alcohol-related birth defects such as fetal alcohol
syndrome.

Foods to Avoid: Avoid fish with high levels of mercury, unpasteurized

food, and raw or uncooked meat, fish, and eggs.

Avoid Extreme Dieting: Women who follow extreme diets to lose

weight during pregnancy can deprive themselves and their babies of
essential nutrients.

© Copyright 2019 Cornerstone OnDemand Foundation 10

Vitamins and Supplements During Pregnancy
Vitamins and supplements help prevent and lower the risk of disease and serious complications during
pregnancy, especially in malnourished pregnant women. Health care providers should advise women
on the recommended daily intake of vitamins, minerals, and supplements throughout pregnancy.

All Women Who are Trying to Conceive or Who Are Pregnant

All Pregnant Women

Need iron (30 mg to 60 mg) and folic acid (400 µg [0.4 mg]) daily to prevent maternal
anemia, puerperal sepsis, low birth weight, and preterm birth

Should not take vitamins B6 (pyridoxine), E, C, and D; multiple-micronutrient

supplementation; or zinc supplementation (without extensive research)

Pregnant Women with Low Dietary Calcium Intake

Need daily calcium supplementation (1.5–2.0 g) oral elemental calcium to reduce the risk

Pregnant Women with or at Risk of Anemia

Need intermittent oral iron and folic acid supplementation (120 mg of elemental iron and
2.8 mg of folic acid) once weekly to improve maternal and neonatal outcomes

Pregnant Women in Areas with Severe Vitamin A Deficiency

Need vitamin A supplementation to prevent night blindness

Pregnant and Lactating Women, and Children Under Age Two in Areas
with Insufficient Iodized Salt
Need supplementary iodine to ensure optimal brain growth

Pregnant Women Prone to Malnutrition

Should increase daily energy and protein intake to reduce the risk of low birth weight

Need balanced energy and protein dietary supplementation to reduce the risk of stillbirths
and babies who are small for gestational age

Should not take high-protein supplementation to improve maternal and perinatal

outcomes

© Copyright 2019 Cornerstone OnDemand Foundation 11