For some women, pregnancy runs smoothly with only a few minor niggles along the way. But others can experience troublesome symptoms, from morning sickness and headaches to heartburn and swollen ankles.
Pregnancy is a time of huge changes in a woman’s life, both physically and emotionally, and many women will visit their local pharmacy for advice, support and suitable over-the-counter products. So how can pharmacy staff help their pregnant customers keep themselves healthy from top to toe?
Headaches in pregnancy are often triggered by hormone fluctuations or fatigue. And some women notice their headaches occur more frequently in the first trimester. “It’s safe to take paracetamol during pregnancy, but medicines containing ibuprofen should be avoided,” says London GP Dr Philippa Kaye, author of The First Five Years.
“If paracetamol isn’t sufficient, women should be advised to see their doctor to rule out other causes of headache and to obtain other pregnancy-safe medication. Women may find that a cold compress on their forehead, exercise or massage of their neck and scalp may also help. If they suddenly develop headaches later on in their pregnancy, they should inform their antenatal team, as this can be a sign of pre-eclampsia.”
Not all pregnant women have a ‘rosy glow’. Many experience spots and acne and/or sensitive skin rashes, especially in the early months. If customers notice any skin changes, they may need to adapt their usual skincare routine. Around 70 per cent of pregnant women develop blotchy areas of darkened skin, usually on their face, called the ‘mask of pregnancy’ or ‘chloasma’.
Sunlight makes the pigmentation worse, so sun protection is important. Dry, itchy skin may also develop as the skin stretches (especially on the tummy). However, generalised itching should be taken seriously, as it may be a sign of a liver problem called obstetric cholestasis.
Swollen, bleeding gums are a common problem in pregnancy, so women need a good oral hygiene routine. There’s growing evidence that gum disease during pregnancy can lead to premature or underweight babies. Fortunately, women can have free dental treatment on the NHS during pregnancy and for one year after their baby is born.
“It’s vital that women maintain a high standard of oral hygiene at this time,” says Dr Nigel Carter OBE, chief executive of the British Dental Health Foundation. “This includes twice daily brushing with fluoride toothpaste, cutting down on the frequency of sugary foods and drinks and visiting their dentist regularly. There’s no need to use a softer toothbrush.”
According to the Royal College of Obstetricians and Gynaecologists, one in three women experience morning sickness. Many women lose their appetite, but they should eat little and often to keep their strength up. If their sickness is triggered by certain smells or foods, they should avoid these if possible.
Some women find that fresh ginger or ginger biscuits help to ease nausea and vomiting. Acupressure bands may also be effective. Severe symptoms should always be taken seriously. A report in April 2015 by the British Pregnancy and Advisory Service and Pregnancy Sickness Support revealed that over one in 100 pregnant women are diagnosed with hyperemesis gravidarum (excessive nausea and vomiting). This can cause severe dehydration and needs medical treatment.
Many women experience heartburn for the first time in pregnancy. “Women should see if there are any food triggers that may be affecting their symptoms,” says Dr Kaye.
“These are commonly caffeine, spicy foods, citrus, pickles and rich/oily foods. If they notice that a particular food gives them symptoms, they should try avoiding it. Other useful advice includes: try not to eat too late in the evening; sit up after eating, and prop themselves up on a few pillows at night to see if this helps.
Over-the-counter medicines containing antacids and alginates can be useful, although women should speak to the pharmacist before starting any medication in pregnancy. The doctor can prescribe medicines such as ranitidine if they are still uncomfortable.”
Headaches in pregnancy are often triggered by hormone fluctuations and fatigue
Stretch marks usually begin on the breasts, tummy and thighs in the second trimester when the body’s elastic skin stretches and breaks. They look red at first and then fade to a silver-grey. Women are most prone to stretch marks if they are carrying twins (or more) or gain a lot of weight in pregnancy.
“Anecdotal evidence suggests that intensive moisturising of ‘risk’ areas throughout pregnancy could reduce the formation and appearance of stretch marks,” says Numark information pharmacist Michael Stewart. “There are oils and moisturising products marketed specifically for this use.”
Around two-thirds of women develop piles during their first pregnancy, with one in 10 noticing them in the third trimester. Haemorrhoids are varicose veins around the anus, and can cause a small lump, itching, pain or bleeding. Constipation is the main cause, combined with pregnancy hormones and the weight of the baby.
“If a woman develops haemorrhoids, she may find that treating any constipation may help. But if changing her diet isn’t sufficient, she should speak to the pharmacist about pregnancysafe laxatives,” says Dr Kaye.
“The discomfort of haemorrhoids can be treated with ice packs and with haemorrhoid creams,although again women need to speak to their pharmacist for advice before starting any medication in pregnancy. Be sure to wipe the area properly; some people prefer using a moistened tissue to wipe, but try to avoid scrubbing as this will make the area sore.”
According to TENA, up to 69 per cent of pregnant women and new mothers experience light bladder weakness (stress incontinence). “Stress incontinence occurs when weakened pelvic muscles can’t control the passing of urine,” says Michael.
“The bladder is put under sudden pressure, such as sneezing, coughing, laughing, heavy lifting or exercise. Some women use sanitary pads and tampons in place of specially designed incontinence pads, but this isn’t recommended as these products are not designed for odour control, rapid absorbency and large quantities of fluid.”
Doing pelvic floor exercises is the best way to prevent and treat stress incontinence related to pregnancy. “A wellfunctioning pelvic floor is very important, both before and after delivery,” says Rachel Bromley, Nuffield Health senior physiotherapist and clinical specialist lead for women’s health. “If women aren’t sure what they should be doing, they should consult a specialist women’s health physiotherapist, who can provide one-to-one help and advice.”
When pregnant, the ligaments in the body become softer and stretch to prepare the body for the baby’s birth. This can put strain on the joints in the lower back and pelvis, which can cause back pain.
Wearing flat shoes, not lifting heavy objects and getting enough rest can all help to protect the back. The National Institute for Health and Care Excellence (NICE) advises that exercising in water, massage therapy, and back care classes might also help to ease back pain in pregnancy.
During pregnancy, women retain more fluid than usual. “To ease swollen ankles, women should keep their feet up,” says Dr Kaye. “Lying on their left side takes the pressure off pelvic veins. If they can’t lie down, simply raising their feet (e.g. putting them on a stool when sitting) can help, as can avoiding standing for long periods of time.”
“Whether they are sitting or standing, they should keep their legs moving, rotate their ankles and stretch their calves. Wear flat comfortable shoes, exercise and drink plenty of fluid – this helps the body retain less water.” If a woman’s feet or ankles suddenly become extremely swollen; the swelling affects only one side, or their face becomes swollen, they must seek urgent medical help, as these symptoms could indicate a more serious condition.
Up to 69 per cent of pregnant women and new mothers experience light bladder weakness
Originally Published by Training Matters