1 Min In OTC
Follow this topic
Bookmark
Record learning outcomes
Getting pregnant can be both exciting and daunting for women and their partners. Trying to conceive, looking after one’s body during pregnancy and preparing for life with a newborn are all elements of the pregnancy journey that hopeful parents will be looking for guidance on. Whether customers are carefully planning their journey or are taking it on as it comes, the pharmacy can support them with nutritional, lifestyle, treatment and self care advice.
In preparation
Whilst trying to conceive and during pregnancy, there are many things women can do to firstly improve their chances of conception, and secondly, to ensure that the foetus gets all the nutrition it needs – starting with supplements. “A balanced diet is key for fertility, but certain supplements can help ensure optimal nutrient intake,” says Nichola Ludlam-Raine, specialist dietician, British Dietetic Association spokesperson and author (How Not to Eat Ultra-Processed: nicsnutrition.com). “Recent evidence suggests choosing to take a combined prenatal multivitamin and mineral supplement might help with fertility.” Nichola recommends that prenatal supplements should include:
- “Folic Acid – a 400mcg daily supplement is recommended before conception (ideally three to six months before) and during the first 12 weeks of pregnancy to reduce the risk of neural tube defects. Women at higher risk (e.g., those with diabetes or coeliac disease, or a BMI over 30) should take 5mg, prescribed by a GP. Women should also include folate-rich food in their diet, such as green leafy vegetables, wholegrains and beans
- Vitamin D – a daily 10mcg supplement is needed to prevent deficiency and support foetal growth during pregnancy (due to a lack of sunlight in the UK, guidance recommends supplementation)
- Iodine – 150mcg per day supports thyroid function and brain development in early pregnancy.
In addition to the above, those following a vegan diet may want to consider having fortified foods or taking a supplement containing vitamin B12, calcium, and omega 3. Iron may also be needed, especially if deficiency is apparent.”
During pregnancy, Nichola advises a multivitamin with 400mcg folic acid and 10mcg vitamin D, in addition to iodine, “especially if the mother is vegan or has low intakes of fish and dairy”.
“A balanced diet is key for fertility, but certain supplements can help ensure optimal nutrient intake”
Don’t downplay diet
As always, diet is important. While many women may experience weird and wonderful cravings during their pregnancy, the basis of the diet should be focused on a variety of whole foods containing vitamins, minerals and fibre. “A diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats provides essential nutrients,” says Nichola. “Adequate water intake helps prevent constipation and supports circulation”, while caffeine should be limited to 200mg per day, which is around two cups of coffee or four cups of tea. Caffeine is believed to cause blood vessels in the uterus and placenta to contract, reducing blood supply to the foetus. This can inhibit growth and/or increase the risk of complications – so energy drinks should also be avoided. “Avoid alcohol and high-risk foods [such as] liver and game meats, raw or undercooked meat and fish, cold cured meats (unless cooked thoroughly), soft cheeses made from unpasteurised milk, and high-mercury fish,” says Nichola. “Tuna should be limited to two fresh steaks or four cans a week, and raw or partially cooked eggs that are not British Lion or produced under the ‘Laid in Britain’ scheme [should also be avoided]”. Cooked eggs, however, Nichola does recommend, as “protein is essential for the baby’s growth, so cooked meat, fish (limit oily fish to twice per week), eggs, beans, lentils and dairy” are fundamental to a pregnant woman’s diet.
Focus on fertility
Everyone’s pregnancy journey is different, and this begins with conception. Along with taking supplements and eating a balanced diet, “understanding a female partner’s cycle is very important for couples trying to conceive, and in general from a women’s health point of view,” says Harish Bhandari, reproductive medicine consultant and treasurer-elect of the British Fertility Society.
While some people will be able to conceive without careful planning, knowledge about a woman’s menstrual cycle will help trying couples. “The general rule of thumb is that if the woman has a regular menstrual cycle, it signifies regular ovulation, which is one of the fundamental factors required for a successful, spontaneous pregnancy,” says Harish. “If the menstrual cycle is irregular, it signifies that the ovulation is irregular, and if the female partner does not have menstrual periods, then they are not ovulating.” There are various reasons for this, including gynaecological conditions such as polycystic ovary syndrome (PCOS), for which women should receive help from their GP. “Irregular and infrequent cycles or their absence signifies hormonal and/or health issues and they should be encouraged to seek help sooner if they are trying to conceive,” says Harish.
Many women have taken to using menstrual cycle tracking apps to let them know when they are ovulating. As these apps track cycles from month-to-month, they can estimate when women may be at their most fertile. However, these are not entirely accurate, warns Harish. “In general, women ovulate two weeks before the onset of the next menstrual period. However, we know from studies that this may not always be accurate and that even with a regular menstrual cycle, women may still ovulate on different days. Hence, we do not encourage women to use these apps routinely to time sexual intercourse around the time of ovulation.” While they can act as a guide, apps should not be solely relied upon. “The NICE guideline in the UK suggests that the heterosexual couple should have regular sexual intercourse, every two to three days,” says Harish. This may be unrealistic for couples as work, social obligations or medical reasons (a partner having a viral infection spread through intercourse) may make this unachievable, Harish recommends that couples “can aim to have unprotected sexual intercourse from six days prior to ovulation, ending on the day of ovulation, which according to evidence, provides the best chance of conceiving spontaneously”.
Customers who have been on long-term contraception, such as the contraceptive pill or the copper coil, may be worried about when they will be able to conceive after stopping their contraception. “The return of fertility following the use contraceptive pills is generally quick, and if there are no pre-existing issues such as polycystic ovary syndrome or premature ovarian insufficiency, a woman can conceive or start trying as soon as they have stopped the pill and can fall pregnant easily,” says Harish, and this is the same for women who have used the Mirena or copper coil. “The return of menstrual periods and fertility after stopping the Depo-Provera injection or removal of contraceptive implant for some women is a little inconsistent, which can take anything up to six months or longer in a minority of women,” he adds.
Exercise is good for you!
If pregnant couples are worried about causing damage to the foetus by exercising, let them know that this theory is quite contrary! In fact, the more active and fit one is during pregnancy, the easier it will be to adapt to the body’s changing shape and weight gain, with evidence that active women are less likely to experience problems later in pregnancy and labour. The NHS recommends that pregnant women keep up their normal daily physical activity or exercise for as long as they feel comfortable.
“Staying active is beneficial and can help with reducing back pain, gestational diabetes risk, and excessive weight gain, while also supporting mental health,” says Nichola, although she does recommend that high-impact or combat sports are avoided. The NHS cautions, however, that pregnant women should not exhaust themselves with strenuous exercise. As a general rule, women should always warm up before and cool down after exercising, and should be able to hold a conversation whilst exercising. Women who were not active before their pregnancy should not suddenly take up strenuous exercise, too, but can still keep active through activities like walking, yoga and swimming. Those attending workout classes should always let the instructor know that they are pregnant.
One type of exercise that women can do throughout their pregnancy is pelvic floor exercises to help to strengthen the muscles of the pelvic floor, which comes under great strain during pregnancy and childbirth. “If your pelvic floor muscles are weak, you may find that you leak urine when you cough, sneeze or strain,” says the NHS. This is completely normal, but can be helped by exercises which strengthen these muscles.
Pregnancy-approved vaccinations
Pregnant women can get a number of vaccinations to shield their babies. Some are strongly recommended by the NHS, whilst others contain potential risk factors, and few are not advised. Customers should check with their midwife or doctor before receiving a vaccine, but the following are safe to recommend:
Last year saw a rise in the number of whooping cough cases in the UK, an infection that can be very serious for young babies who are most at risk. The NHS recommends that all pregnant women receive the whooping cough vaccination during their pregnancy, from 16 weeks up until 32 weeks (although women can still receive it later), to give their babies the best protection against the infection. This is crucial, as once they are born, babies are unable to have their vaccine until they are eight weeks old.
Respiratory syncytial virus (RSV) is a common virus, but a serious one for babies to contract. It can cause dangerous lung infections like pneumonia and bronchiolitis which, most of the time, need to be treated in hospital.
Women should be offered the RSV vaccine around the time of their 28-week antenatal appointment and are advised to get vaccinated as soon as possible from 28 weeks to provide the best protection – babies whose mothers are vaccinated during pregnancy are less likely to get severe RSV for the first six months after they are born.
Pregnant women are more at risk of experiencing complications from the flu, as their immune systems are weakened to protect the pregnancy. The NHS recommends women planning on or who are currently pregnant get the flu vaccine to lessen chances of getting the flu and the severity of it, if it is contracted.
For more information on vaccinations recommended for pregnancy and those that are not safe for pregnant women, visit: nhs.uk/pregnancy/keeping-well/vaccinations/.
There are several vaccinations pregnant women should consider having to ensure maximum protection for their baby.
Smooth as a baby’s…
Newborn babies are prone to developing a few skin conditions, but many of them can be treated with either self care advice or treatment found in the pharmacy. We discuss a few of the common conditions below:
Seborrheic dermatitis (cradle cap) “is a common skin condition in infants and newborns that result from mild yeast overgrowth [which leaves] yellow or white scales on the scalp,” says Dr Latanya Benjamin, paediatric dermatologist. It usually goes away on its own, but parents can lightly massage an emollient onto the scalp to loosen the scales or gently brush the scalp with a soft brush before washing with baby shampoo. It is important that the scales are not picked, as this can lead to infection. Any sign of leaking or bleeding should be seen by a GP.
“Infantile eczema can develop from birth to six months,” says Dr Benjamin. “The cause results from a complex interaction between genetics, the epidermal barrier and its interplay with the immune system and environment.” In infants, eczema usually appears on the face, chin, forehead, cheeks and scalp, but it can also spread to other areas. On white skin, eczema presents as a red rash and as a white, purple rash on darker skin.
Nappy rash shows up as red or raw patches on the baby’s bottom or whole nappy area. The skin may become dry, itchy and painful and in some cases pimples and blisters may develop. If the baby is experiencing discomfort, you should refer the parents to the pharmacist, but there are simple ways to treat it from home:
- Change wet or dirty nappies as soon as possible
- Keep the skin clean and dry
- Leave nappies off when possible
- Use fragrance-free and alcohol-free wipes
- Bath your baby daily, no more than twice a day.
In OTC