Pregnancy is an exciting time, but it can also be a stressful one. There’s no end to the amount of advice on pregnancy and baby care forums and websites, with regular snippets doled out by friends and family as well. But despite, or perhaps because of all of this, pregnancy can still cause confusion.
Mothers-to-be have access to professional advice and support through their GP and midwife. But they may still visit the pharmacy for advice, as this is often more convenient than visiting their GP surgery. Here are answers to some common questions about healthy eating and exercise, pregnancy-related symptoms and key infant ailments, so that pharmacy staff can make sure everyone is prepared for the new arrivals.
Fatigue can be one of the first signs of pregnancy. If pregnant women need to sleep in the day, and have the opportunity to do so, they should indulge whenever they can.
“It’s not surprising that women feel exhausted early on in pregnancy as their body is going through so many changes in the first 12 weeks,” says Dr Sarah Jarvis, GP and clinical director at Patient UK. “It’s easier to cope with the tiredness if this s a first baby rather than a second or third. Women should be encouraged to put their feet up after work and rest on a weekend, take their antenatal vitamins and keep an eye on their weight gain.”
There’s no evidence that taking a specially formulated ‘pregnancy’ supplement is essential. However, women should take 400mcg of folic acid a day from the moment they conceive and for the first three months of pregnancy. They also need to take 10mcg of vitamin D every day throughout their pregnancy and while breastfeeding.
“In early pregnancy, a daily folic acid supplement is recommended to prevent birth defects such as spina bifida,” says Dr Dan Robertson, GP and medical officer at Push Doctor. “While folic acid is present in green veg and some fortified cereals, more is needed during pregnancy. Mums-to-be also need plenty of vitamin D, as this helps to process the calcium a baby needs for healthy bones, teeth and muscles. Women on medication for epilepsy or where there is a family history of spina bifida should speak with their GP about taking a higher dose of folic acid prior to conception.
“Other nutrients that are important for pregnant women, such as iron, calcium and vitamin C, can all be found in adequate amounts in their diet, without the need for supplements.”
When it comes to alcohol intake, the safest approach is to avoid alcohol completely during pregnancy. However, Dr Jarvis says if women don’t know they’re pregnant and have been drinking, they shouldn’t panic as the baby is likely to be unaffected.
The old adage that pregnant women need to ‘eat for two’ is somewhat of an urban myth and it’s what they should eat that’s key. “It is important women eat a healthy diet with plenty of fruit and vegetables and fibre to reduce constipation,” says Dr Jarvis. “Protein foods are important, especially if customers are vegetarian or vegan, with calcium-rich foods such as dairy products or fortified soya products. Women need iron from dark green vegetables, pulses and fortified cereals, but should avoid vitamin A in cod liver oil and pâté. Pregnant women can now eat raw egg as long as it has been stamped with the Lion mark, but should avoid soft cheeses with skin, blue cheese, raw fish and shellfish. Caffeine should be limited to 200mg a day from tea, coffee, cocoa, chocolate and cola.”
Women can continue to exercise during pregnancy but should be aware of their limitations and avoid contact sports. Changing pregnancy hormone levels affects muscle tone, making women more susceptible to strains, aches and pains.
“Any exercise that helps improve muscle tone will have a positive outcome on the ongoing pregnancy,” says Jackie Hall, registered midwife and Health at Hand operations manager at AXA PPP Healthcare. “Exercising and maintaining a healthy diet will also help reduce the risks of gestational diabetes and other complications in pregnancy. If a woman has any concerns regarding exercise in pregnancy, she should be encouraged to talk to her midwife or her exercise coach or teacher to help evaluate what changes can be made to make exercise more achievable.”
Morning sickness or nausea often strikes women in early pregnancy. Some women find certain tastes or smells make them feel sick. If they are vomiting severely and can’t keep fluid down, they may need a short hospital admission to be rehydrated.
“The best way to stave off those waves of nausea is to keep your blood sugar steady by eating regular small amounts of complex carbohydrates such as brown bread and butter, whole wheat crackers, bananas etc.” says midwife Rachel Fitz-Desorgher.
“Overnight, stop your blood sugar dropping by sipping squash or fruit juice and eating a little brown bread and butter whenever you wake up to go to the loo or change position. Extra rest can also help. If you can’t keep anything down or are losing weight, see your midwife or GP.”
Most women notice stretch marks during pregnancy as their bump grows. “Stretch marks are caused by over-stretching of the middle bit of the ﬂesh (the dermis),” says Rachel.
“Avoiding piling on too much weight can reduce your risk but mostly it comes down to the type of skin you have. Creams and oils make no difference but some of them might help reduce the itching that stretch marks can cause. If you have a lot of very itchy stretch marks, see your GP who might be able to prescribe something to help."
Headaches may be associated with tiredness or dehydration, but some can be a sign of pre-eclampsia in later pregnancy. "For some, allowing themselves more time to relax is enough," says Dr Robertson. "For others, painkillers are necessary. While some over-the-counter medicines are ﬁne, it’s important that women consult a doctor so they know what they’re taking is safe and that they don’t exceed the recommended dose. Ibuprofen carries risks during early and late pregnancy and should be avoided. Paracetamol is generally accepted as a safer alternative. There is no ﬁrm evidence that it is harmful during pregnancy but should always be taken at the lowest effective dose for the shortest time possible.”
Weak pelvic ﬂoor muscles are a common cause of stress incontinence and women should start doing pelvic ﬂoor exercises during pregnancy to reduce the risk of it developing. “Prevention is better than cure so women should commence straight away,” says Laura Spicer, midwife at The Women’s Health Clinic. “Get into a routine every time you put the kettle on or during the ad breaks on the sofa and you’ll be in a rhythm in no time.”
As long as women are otherwise well, puffy hands and ankles are normal in pregnancy, as the body retains more ﬂuid that usual. However, it’s important that women discuss this with their midwife.
“Some pufﬁness is normal, especially in the last three months,” says Dr Jarvis. “This is more likely to be noticeable in hot weather or at the end of the day. But swollen hands and ankles in late pregnancy can also be a sign of preeclampsia. Women are checked for pre-eclampsia during pregnancy. But if their symptoms suddenly get worse, they should see their GP straight away to have their blood pressure and urine checked.”
Heartburn is very common during pregnancy. “Some women ﬁnd that eating certain foods, eating too fast or too much, lying down for a long time or bending down can lead to heartburn,” says Dr Robertson. “Eating and drinking small amounts often and avoiding eating before going to bed may help. Some OTC medicines may be suitable and can be discussed with the pharmacist. If their symptoms are severe, [proton pump inhibitors] can be used during pregnancy but clearly this will need discussion with their GP in the ﬁrst instance.”
Research published in August 2017 by Unicef and the World Health Organization shows that the UK has one of the lowest breastfeeding rates in the world. Only 34 per cent of babies in the UK are breastfed for six months. If mothers are struggling to breastfeed, they should speak to their midwife or health visitor. They may need to review the way their baby is latching on.
“As a mother’s body adjusts to breastfeeding, she may experience discomfort and complications,” says Tamara Bugembe, founder of Helper Bees childcare agency. “Unpleasantly engorged breasts can be soothed with cooled cabbage leaves or bra inserts. Massaging the breast with a warm ﬂannel before a feed and cold ﬂannel after a feed can also help ease the discomfort. If the pressure becomes unbearable, try to hand express the excess milk. Women should see a doctor if their breasts are swollen, hot and painful and they feel ﬂu-like or have a fever.”
Infant formula choices
If parents choose to bottle feed, they need to decide which infant formula milk to use. “In the UK, all infant formulas must, by law, provide all the calories, vitamins and minerals a baby needs,” says midwife Rachel Fitz-Desorgher.
Parents need to know how to make up bottles correctly, using sterilised equipment and freshly boiled water. “The making up of formula feeds has changed,” says Laura Spicer, midwife at The Women’s Health Clinic. “It is now recommended to make each individual feed up due to bacteria growth, which means no more making up a batch of six, like our parents would have.”
Babies naturally have low body temperatures. If their temperature is higher than usual, they need plenty of ﬂuids and should be dressed in light clothing.
“If babies are under three months, seek medical help if their temperature is over 38˚C,” says Patient UK’s Dr Jarvis. “If they are over three months, parents can give them baby paracetamol or baby ibuprofen. It’s worth checking the Patient.co.uk leaﬂet on fever in children as this gives the red ﬂag signs to look for. Doctors no longer recommend tepid sponging or cool fans.”
Babies’ skin is very delicate and can become sore easily if it’s not kept clean and dry. A barrier cream will protect any raw skin and allow it to heal.
"Check the nappy at each feed and change it as soon as it is wet or dirty,” says Rachel. “Use plain water and cotton wool or a fresh ﬂannel and wash the whole nappy area, taking care to check the deep creases. Dry gently with cotton wool or a soft towel and then pop on a clean nappy. If your baby does get nappy rash, continue to clean her bottom and genitals as described above and then leave the nappy off whenever you can for a short while. A little petroleum jelly lightly smeared over the sore area will act as a barrier against the pee and poo whilst the skin heals itself.”
Some teething babies become more unsettled, have one hot, ﬂushed cheek, chew on things all the time and dribble more than usual. “Once you have excluded anything serious and established that a tooth is sprouting, give the baby something cool and clean to chew on like a piece of frozen fruit (e.g. bananas), a cold teething ring or wet ﬂannel,” says Tamara. “Avoid sugary products that may cause tooth decay or foods that may break into chunky pieces and cause choking. If babies are very irritable and not sleeping or eating, some liquid paracetamol may help in babies over three months.”
Colic affects babies under four months of age. It is characterised by bouts of pain and crying in the late afternoon or early evening. The baby is otherwise well. “Holding a baby isn’t usually enough to console them, so take them for a drive in the car or take the baby out for a walk,” says Dr Jarvis. “Dealing with a baby with colic is exhausting so it’s important that parents get a rest as well. There is some evidence that products like lactase drops, which break down lactose, can help, as well as gripe water. Try winding the baby properly and use white noise to get them to sleep.” Nutritional solutions, such as specialist infant formula milks, may also help but a healthcare professional must check that these are suitable and recommend as appropriate.
Babies have very sensitive skin, so parents should stick to fragrance-free baby products. “Even simple oils can make your baby itchy,” says Rachel. “Stick to plain water for nappy changing and bathing. Eczema tends to be inherited and can cause red, itchy patches. If your baby has irritating sore patches, make sure your GP sees it so that the correct treatment can be prescribed."
If they are vomiting severely and can’t keep ﬂuid down, they may need a short hospital admission to be rehydrated