Scenario

Dan Harrison pops into the pharmacy. Technician Vicky, who is good friends with Dan’s wife Charlotte, comes out to the counter to say hello.

“Oh hi Vicky,” says Dan. “I need a cold remedy for Charlotte. It’s run of the mill stuff – runny nose, but bunged up, bit of a cough, sore throat, aches, a bit of a temperature, but nothing serious. What have you got?”

Vicky turns to the shelves behind her, saying over her shoulder: “She’s not on anything else, is she, Dan?” “No, nothing except folic acid tablets. She’ll kill me for telling you, Vicky, because I know she wants to wait a bit longer, but she’s six weeks pregnant.”

Answer

Many of the cough and cold products available over the counter are not licensed for use in pregnancy, so Vicky should recommend that Charlotte restricts herself to paracetamol for the achiness and fever and uses self-help measures to combat the rest of her symptoms, such as:

• Drinking plenty of fluids to replace those lost from having a runny nose and a fever, including hot drinks to help soothe her sore throat
• Using steam inhalations to help liquefy nasal mucus, relieve congestion and keep the inside of the nose moist
• Aromatic compounds such as eucalyptus oil and menthol can be added to steam inhalations, dabbed on a tissue or pillow, or applied in the form of chest rubs.

Products containing antihistamines or cough treatments are not supported by evidence so should not be recommended, and decongestant ingredients are not considered suitable for use by pregnant women. Ibuprofen is not recommended during the first trimester of pregnancy because it may cause miscarriage or abnormalities in the developing baby.

The bigger picture

Dan’s visit to the pharmacy provides the perfect opportunity for Vicky to highlight some of the vaccinations that Charlotte should give serious consideration to having during her pregnancy. Of particular importance at this time of year is the seasonal flu vaccine, which is recommended for all pregnant women because they are more likely to suffer complications such as bronchitis if they succumb to the infection.

Flu in the later stages of pregnancy can also harm the unborn child by precipitating premature labour or causing the baby to be born at a low birthweight. It can even lead to stillbirth or neonatal death. The second vaccination Vicky should mention to Dan is against whooping cough.

Immunisation during pregnancy is important in order to protect babies from the condition in the first few weeks of life, before they receive their own vaccination at eight weeks of age as part of the childhood immunisation schedule. Whooping cough, also known as pertussis, can have serious consequences, such as pneumonia, brain damage and even death for young babies who contract it. The whooping cough pregnancy vaccination programme has been brought in relatively recently following a substantial increase in cases in 2012.

That year, over 9,000 cases were reported in England, 400 of which were in babies under three months old, and 14 babies died as a result. The pertussis vaccine is given later in pregnancy – usually between 28 and 32 weeks, although it can be administered up to and including week 38.

Women should not delay being immunised against flu in order to have the two vaccines at the same time. Both vaccines are considered safe in pregnancy, with no evidence of risk to either mother or baby.

Extend your learning

• Read the information on medicines use during pregnancy in the “Guidance on prescribing” at the beginning of the British National Formulary, which should be available in your dispensary. It is also available electronically here (registration required)
• Is your pharmacy signed up to TOXBASE, the telephone and online information service set up by the UK Teratology Department as commissioned by Public Health England? Access is free to all NHS and NHS-affiliated departments, units and practices in the UK. Go to the TOXBASE website to find out more
• Look at the Best Use of Medicines in Pregnancy (BUMPS) website, which has been set up by UKTIS to provide high quality advice to healthcare professionals and patients, and has a reporting facility for pregnant women. Online here , of particular interest is the section that contains leaflets for many commonly used drugs.