Folic acid supplements taken before and during early pregnancy cut the risk of neural tube defects by about 72 per cent. But a recent British Medical Journal study revealed that the prevalence of neural tube defects occurring has not declined substantially in the past 20 years. And according to research published in the Archives Of Disease In Childhood, most women don’t take dietary supplements recommended before and during pregnancy.
As a result, the Royal College of Obstetricians and Gynaecologists (RCOG) is calling for mandatory fortification of bread or flour with folic acid in the UK, as well as better guidance on vitamin and mineral supplement use.
So does this mean there’s a need for more of a focus on pre-pregnancy and pregnancy advice from community pharmacies at point of sale? And should community pharmacy teams look to expand on the relevant products that they offer in this category?
Stuart Gale, chief pharmacist and owner of the Frosts Pharmacy Group in Oxfordshire, says there is clearly a great deal of work still to be done in educating those who are trying to conceive, and the network of local pharmacies is a great place to start. “We have known about the benefits of taking folic acid for years, but the dangers of failing to take it during conception and early pregnancy seem to have dropped out of the headlines,” he says.
“Of course, that doesn’t mean the danger has passed. Pharmacies are ideally placed to offer advice on pre-pregnancy planning. It often seems that the only time we pharmacists get to speak to patients is when there is a problem. This is a real shame, given that we see more patients than anyone else.”
According to Sultan “Sid” Dajani, independent community pharmacist and member of the RPS English Pharmacy Board, pharmacists and other healthcare professionals need a national push in relation to pregnancy. “It’s not just what women can do once they are pregnant or their baby is born, but also beforehand,” he says.
“Pharmacists may be able to ask if a customer is trying for a baby during an MUR, especially if they are discussing medication. But they also need to highlight key issues, such as folic acid, vitamin D, flu jabs and gestational diabetes, with a health-promotion campaign involving posters and shelf edgers at the baby and pregnancy sections.”
Since folic acid is most effective before pregnancy, advice needs to start before women conceive. “With modern pregnancy tests indicating pregnancy far earlier than previously, it should be possible for pharmacists to identify and have a conversation with women about this,” says Hilary Cunningham, information pharmacist at Numark.
“Educating the pharmacy team on how ovulation kits and pregnancy tests work will ensure the whole team can provide appropriate advice and build customer loyalty. Fertility kits and ovulation kits should be merchandised adjacent to pregnancy tests; they are often similar brands, so the same rules about beacon branding apply.”
“As well as the usual folic acid recommended for women trying to conceive, there are also pre-conception vitamins for both women and men, from brands such as Pregnacare. These are generally merchandised in the women’s health section of VMS, but there is no reason why they can’t be dual-sited to help with link selling alongside the fertility/ovulation kits.”
According to NHS Choices, around one in seven couples may experience difficulty conceiving. For some people, leading a healthy lifestyle may help to prevent fertility problems. “For some couples, trying to conceive can often take much longer than expected,” says Professor Nick Raine-Fenning, consultant gynaecologist and reproductive specialist at Nottingham University Hospital.
“Pharmacists are well placed to offer advice in this area, in a discreet setting, about the options available to help couples struggling to conceive before they go to see a fertility expert. This includes making lifestyle changes or trying innovative products that are available in the pharmacy, such as The Stork home conception kit, which is clinically proven to deliver a higher concentration of sperm directly to the cervix compared to natural intercourse.”
Achieving a healthy weight increases the odds of conceiving and maintaining a successful pregnancy. But it’s important that women get pregnancy-specific advice, rather than cut out essential food groups. Weight gain in pregnancy varies from woman to woman, and women need to know how to monitor their weight at a time when they will naturally be putting some weight on.
Martina Janeckova, head of marketing at Qardio Inc, says pregnant women need to assess their BMI (body mass index) value, rather than actual weight. “Today, smart scales can offer an easy way to measure and reach a woman’s optimal weight, also analysing fat percentage or water composition,” she says “QardioBase incorporates a pregnancy mode to safely track a week-by-week progress during this happy time and beyond.”
Ms Cunningham suggests pharmacists play to their strengths, ie offer product advice, which customers are unlikely to be given in a supermarket or online. “Link-selling appropriate folic acid or vitamin products and talking about healthy eating and lifestyle will all give customers reasons to come back,” she says. “Women wishing to stop smoking could be referred to the stop smoking service provided within the pharmacy.”
“Pharmacists and their teams can also advise pregnant women on appropriate action to help overcome some of the common ailments associated with pregnancy, such as morning sickness, fatigue or lethargy, heartburn, indigestion, constipation or haemorrhoids. Pharmacists are also well placed to increase the uptake of the flu vaccine in pregnancy, irrespective of stage, as pregnant women are one of the patient groups eligible for the free NHS flu jab.”
It’s important that relevant advice doesn’t stop when the baby is born. While bladder sensitivity is a common problem for as many as one in three adult women in the UK, many of them can feel too embarrassed to address the subject. Pregnancy can often lead to weak pelvic floor muscles. According to Lourdes Fuentes, P&G Brand Femcare (Always and Tampax), pharmacy teams are in a favourable position to start the conversation on adult incontinence with their customers.
“They can discreetly find out about the specific nature of the customer’s condition, thanks to the one-on-one consultancy they offer,” she says. “We know that many of the women affected don’t use the right product that would offer the best level of protection and discretion to meet their needs.”
Mr Dajani says pregnancy is an ideal time for pharmacists to build up a relationship with a customer in the longer term, so shouldn’t be viewed in isolation. “If women are given good advice when they are trying to conceive, and during their pregnancy, they will be more likely to go back to the pharmacy afterwards and through the baby and childhood years,” he says.
We have known about the benefits of taking folic acid for years, but the dangers of failing to take it during conception and early pregnancy seem to have dropped out of the headlines
Pregnant women are being advised to reconsider travel to parts of the world where Zika virus outbreaks are happening. The virus, spread by the mosquito that spreads Dengue fever, is thought to be responsible for growing numbers of cases of babies born with an underdeveloped brain. Three people from Britain have already been reported to have contracted the virus after travel to South and Central America. Up to four million people worldwide could be infected with the virus this year, says the World Health Organisation.
Guidance on alcohol from the UK’s chief medical officers, issued last month, advises women who are pregnant or planning a pregnancy not to drink alcohol at all. The new policy on alcohol is part of a DH consultation that is due to finish by 1 April.
Fiona McElrea, Whithorn Pharmacy, Whithorn “In our area, we have quite a lot of young women who are either trying for a baby or are having babies. We sell a lot of pregnancy tests, from the cheaper ones to the more expensive ones. It’s the older women, who are actively trying for a baby, that buy the higher-end tests. We site pregnancy supplies within easy sight, because if someone’s in the early stages of pregnancy they don’t necessarily want people to know or have to ask. We have information cards on the shelves signposting advice and information. If people say they’re looking to become pregnant, we would recommend folic acid right away. And we have a local health board initiative where we supply healthy start vitamins for pregnant women and children – we’re in the west of Scotland where there’s a shortage of sunshine.”
Nemesh Patel, Day Lewis Pharmacy, Chelmsford “The fertility market is becoming increasingly popular and Day Lewis has ensured all its teams are ready to advise mothers and mothers-to-be. Combination supplements, particularly the Pregnacare/Preconceive products, are our best sellers. We also provide our own range of products including folic acid, vitamin D and iron products, which aid healthy growth and development of the baby. Pharmacists are uniquely placed to provide comprehensive advice to their customers and will experience an upturn in sales, the more they engage with this flourishing market.”
Rena Dadra, Village Pharmacy, Harlington “Because we have a female only staff in our pharmacy at the moment, we have a lot of women coming in to ask questions. Clearblue Digital is probably our best seller in terms of pregnancy tests. We tend to recommend the digital option because it gives you that extra information, which can be useful, although many people – typically men or younger women – prefer the cheaper options. We’ve recently moved the range to eye level in our pharmacy. Many customers simply walk in, pick up what they want and then leave, but when they’re coming in about fertility it’s different. We’ve got a couple of women on IVF treatment who have private prescriptions, and they spend a lot of time talking to me to discuss their options because they want everyone’s advice.”