Community pharmacies are often the starting point of the pregnancy journey with the purchase of a pregnancy test – and pharmacy teams are always well placed to offer health advice and support when there are the inevitable bumps in the road...
Women are advised to take 400mcg of folic acid every day from before they become pregnant until the end of the first trimester, and also vitamin D 10mcg daily. Some women, such as those with diabetes or taking anti-epileptic medicines, may need to be prescribed a higher dose of folic acid.
Women should speak to their GP about having any recommended immunisations during pregnancy (such as flu and whooping cough).
Around 80 per cent of pregnant women experience nausea and/or vomiting during pregnancy – and at any time of the day, not just in the mornings. It is important to reassure them that mild to moderate symptoms are likely to resolve by 16-20 weeks of pregnancy.
Lifestyle changes may help (e.g. eating small, frequent meals of plain high-carbohydrate foods, drinking plenty of fluids, eating food or drinks containing ginger, or trying acupressure wristbands). A short course of antiemetics (often antihistamines) can be prescribed for more troublesome symptoms.
A severe form of pregnancy sickness (hyperemesis gravidarum) can lead to dehydration and malnourishment, and needs specialist treatment, often in a hospital.
If women experience heartburn during pregnancy, they should focus on lifestyle and dietary changes before trying antacids or alginates. A GP may prescribe a short course of proton pump inhibitors if the symptoms are severe and don’t respond to lifestyle advice, antacids or alginates.
If a pregnant woman experiences constipation, she should initially focus on lifestyle measures, such as increasing her fibre and fluid intake and being more physically active. If these fail to work, a GP may prescribe a short course of laxatives.
Minimising constipation and straining will help to reduce the risk of developing haemorrhoids during pregnancy.
It is common for women to experience increased vaginal discharge during pregnancy, but they should still discuss this with their midwife. If they also have itching, soreness, an unpleasant odour or pain on passing urine, they should be tested for common infections, such as thrush or bacterial vaginosis, and offered appropriate treatments if necessary.
In June 2023, the MHRA issued a reminder to healthcare professionals that the use of systemic (oral and injectable) NSAIDs such as ibuprofen, naproxen and diclofenac is contraindicated in the last trimester of pregnancy (after 28 weeks) and that NSAIDs should be avoided from week 20 of pregnancy onwards unless absolutely necessary and advised by a doctor.
The review didn’t investigate the role and safety of topical NSAIDs (such as gels and creams).
For most parents, pregnancy and early parenthood is an exciting experience. It is also a time of change – physically, emotionally, socially and financially – and this can affect their mental health.
In August 2023, the Royal College of Midwives released a report on ‘Strengthening perinatal mental health’, warning that mental health needs remain secondary to the physical health needs of women during pregnancy in the NHS. Women must receive the mental health support they require, it said.
One in five women will experience mental health issues during pregnancy and up to a year after birth, ranging from anxiety and depression to more significant illness. Suicide remains one of the leading causes of death in new mothers
up to the first year after giving birth.
Dr Ruth Naughton-Doe, at the University of York’s School for Business and Society, is working on a fellowship funded by the National Institute for Health and Care Research to find solutions for both loneliness and mental illness during pregnancy and in the first year after the baby’s birth, as these can have lasting consequences for parents and their children.
“Parents who most need support might not be able to find it due to not knowing where to look, a lack of suitable options or not being able to afford the options available,” she says.
“We know that in the UK, there are organisations such as the National Childcare Trust that run antenatal courses, church-run playgroups, playgrounds, family hubs and community centres. There are some local support options available but new parents still feel lonely, and we need to find out what will help.”
Common baby ailments
These are very common in babies and toddlers. Children under six years shouldn’t be given OTC cold remedies, other than saline nose drops to ease nasal congestion and paediatric paracetamol or ibuprofen to lower a fever or ease any pain. It is important that babies and toddlers with a cold (especially with a fever) drink plenty of fluids. Children over the age of one year can be given warm drinks of lemon and honey to ease a sore throat and cough.
This is a form of seborrhoeic dermatitis that affects babies in the first few months of life. It is harmless but can look unsightly, causing patches of white or yellow greasy, scaly skin on the scalp and face (and occasionally the nappy area). The scales can be loosened by lightly massaging an emollient into the scalp, brushing gently with a soft brush, and then washing with baby shampoo.
Nappy rash causes red or raw patches on the baby’s nappy area. The skin often looks sore and feels hot to the touch, and the baby may seem uncomfortable or distressed. Nappy rash can be treated and prevented by changing nappies as soon as possible, keeping the skin clean and dry, and making sure nappies fit properly (but leaving them off for a while each day, if possible). Using a thin layer of barrier cream will help to protect the baby’s skin.
If a baby cries for more than three hours a day, three days a week, for at least one week, but is otherwise healthy, it may be colic. The cause of colic is unclear and the crying sessions often stop by the time a baby reaches three or four months. As well as crying incessantly, the baby may also be hard to soothe, clenching fists, going red in the face and bring knees up to the tummy or arching the back.
Soothing techniques, including rocking, bathing and walks, are often advised. Many parents also seek treatments such as anticolic drops or granules, herbal and probiotic supplements, and cranial osteopathy, although there is little clinical research proving these approaches work.
Diarrhoea and vomiting in babies and young children is often caused by gastroenteritis. It is important to make sure the baby is getting enough fluids to prevent dehydration. This may involve giving breastfed babies smaller feeds more often or giving babies on formula or solid foods small sips of cooled, boiled water between feeds. If the symptoms continue, or are severe, refer to a GP.
Babies may bring up a little milk, or are sick, during or after a feed. They may also seem unsettled during feeding, swallow or gulp after burping or feeding, or cough or hiccup when feeding. Reflux usually occurs because the baby’s oesophagus has yet to fully developed. If they’re otherwise happy, healthy and gaining weight, babies with reflux don’t necessarily need to see a GP.
A health visitor can provide advice on feeding positions and burping. If the symptoms continue, a GP may recommend a thickening powder, or thickened formula milk, for bottlefed babies. If this doesn’t help, or the baby is breastfed, medicines for reflux may be prescribed.
Many parents worry about dry, peeling skin on newborns, but this is a natural response after the birth as the baby develops its natural protective skin barrier. Midwives and health visitors usually recommend not using any moisturising creams or oils on a newborn baby’s skin but, after a few weeks, if the skin remains dry, emollient products suitable for young babies should be used.
Atopic eczema usually starts in a baby’s first six months. It can cause dry, itchy, sore and cracked skin, especially on the face, inside the elbows and back of the knees. Possible triggers and suitable treatments should be discussed with parents.