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Assessment for nutrition-related disorders in women during pregnancy

Intervention | Last updated: 20 June 2023

Antenatal screening is important to help prevent poor maternal and perinatal outcomes. While screening for pre-eclampsia and blood pressure are considered routine, screening for anaemia and hyperglycaemia are also important.

It is estimated that in 2011, more than 40% of pregnant women worldwide were anaemic. Anaemia increases perinatal risks for mothers and newborns and contributes to preventable mortality. Accurate, low-cost, simple-to-use tests to detect anaemia might improve the identification and subsequent management of women with anaemia, particularly severe anaemia, in resource-limited settings.

Evidence indicates that women with hyperglycaemia (i.e. diabetes mellitus and gestational diabetes mellitus) during pregnancy are at greater risk of adverse pregnancy outcomes including macrosomia, pre-eclampsia/hypertensive disorders in pregnancy, and shoulder dystocia*. Identifying gestational diabetes mellitus during pregnancy allows for effective treatment which may consist of lifestyle changes (e.g. nutritional counselling and exercise) followed by oral blood glucose-lowering agents or insulin, if necessary. WHO currently does not have a recommendation on whether or how to screen for gestational diabetes mellitus, and screening strategies for gestational diabetes mellitus are considered a priority area for research, particularly in resource-limited settings.

*Obstructed labour in which the shoulder of the infant cannot be delivered or is delivered with difficulty after delivery of the infant’s head.

WHO 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.

Hyperglycaemia first detected at any time during pregnancy should be classified as either, gestational diabetes mellitus or diabetes mellitus in pregnancy, according to WHO 2013 criteria.*

* This recommendation has been adapted and integrated from the WHO ‘Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy’ (2013), which states that GDM should be diagnosed at any time in pregnancy if one or more of the following criteria are met:

  • fasting plasma glucose 5.1-6.9 mmol/l (92 -125 mg/dl)
  • 1-hour plasma glucose ≥10.0 mmol/l (180 mg/dl) following a 75g oral glucose load
  • 2-hour plasma glucose 8.5-11.0 mmol/l (153 -199 mg/dl) following a 75g oral glucose load

Diabetes mellitus in pregnancy should be diagnosed by the 2006 WHO criteria for diabetes if one or more of the following criteria are met:

  • fasting plasma glucose ≥7.0 mmol/l (126 mg/ dl)
  • 2-hour plasma glucose ≥11.1 mmol/l (200 mg/dl) following a 75g oral glucose load
  • random plasma glucose ≥11.1 mmol/l (200 mg/ dl) in the presence of diabetes symptoms


Evidence

Systematic reviews used to develop the guidelines

Accuracy of on-site tests to detect anaemia in antenatal care: a systematic review (In press)

Cost-effectiveness Learn More Alternate Text

Relevant cost-effectiveness analyses have not yet been identified.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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