Staying healthy while pregnant and looking after the baby in the early days and months can be challenging, as Steve Titmarsh explains…

Mental illness is not uncommon during pregnancy, and there are many questions around skin care for newborns. Community pharmacies are a great source of advice and support for mums and mums-to-be.

Up to a fifth of women have mental health problems during pregnancy and for up to a year after birth, with around 12% having depression. Mild mood changes are common among pregnant women. The risk of a severe disease such as postpartum psychosis, severe depression, schizophrenia or bipolar disease is low but increases postpartum.¹ 

Women may be affected by anxiety disorders, including panic disorder, generalised anxiety disorder (GAD), obsessive‑compulsive disorder (OCD), post‑traumatic stress disorder (PTSD) and tokophobia (an extreme fear of childbirth), during pregnancy and postnatally. The disorders may occur alongside depression or on their own.²

Spotting problems early is important so that support and treatment, if required, can be accessed as soon as possible. A couple of simple questions can help identify women who may be at risk of, or struggling with depression:³ 

• During the past month, have you often been bothered by feeling down, depressed or hopeless?
• During the past month, have you often been bothered by having little interest or pleasure in doing things?

Those answering ‘yes’ to one or both questions may benefit from a visit to their GP for diagnosis / further help. 

It may also be appropriate to ask women who are pregnant or have given birth recently questions about anxiety:⁴

• Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge?
• Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?

An answer of 'not at all' scores 0; 'several days' scores 1; 'more than half the days' scores 2; 'nearly every day' scores 3. Women who score 3 or more would benefit from referral for medical evaluation.⁵

Women with a history of mental illness, even though they may be well, should be referred to mental health services if they plan to start a family or are already pregnant.⁶

Women taking medication for mental illness who become pregnant need to discuss the risks and benefits of continuing treatment during pregnancy and while breastfeeding.^6,7

Women taking antidepressants for mild-to-moderate depression who become pregnant should be referred to discuss gradually stopping and considering a psychological treatment instead. Pregnant women with severe depression taking antidepressants need to see their prescriber to discuss the risks and benefits of continuing treatment and other options open to them.⁴ 

First-line treatment for women with mild-to-moderate depression is facilitated self-help or psychological therapy for moderate or severe symptoms; pharmacotherapy may be needed.⁴

Women of childbearing potential should not be offered valproate unless other drugs cannot be used because they do not work or cannot be tolerated and there is a pregnancy prevention programme in place. The drug is associated with a significant risk of birth defects and developmental disorders in children born to women who take valproate during pregnancy.^4,8,9

Newborn baby skin care

Baby’s skin is still maturing and developing its protective barrier for the first month or so after birth, which is why it is important to leave the vernix (a white/creamy sticky substance that covers a baby’s skin after birth) as intact as possible. So for the first month at least baby should be bathed using water only and for a short time (about five minutes maximum).^10,11 Premature babies need special care, which neonatal unit staff will advise on.¹⁰

Nappies should be changed regularly to help avoid nappy rash but baby wipes should not be used for the first two to four weeks of a baby’s life. Instead clean with water and allow to air dry or pat dry.¹² 

It is important to protect baby’s skin from the sun. Physical barriers such as clothes, including hats and shade, are preferable to sunscreens in the first few months. If sunscreens are used they should be fragrance-free and hypo-allergenic. Those formulated with zinc oxide or titanium dioxide are preferred over chemical sunscreens.¹³

Products containing peanut oil (arachis oil) or alcohol should not be used on baby’s skin as they may cause sensitivity or allergy. Similarly products containing fragrance or dyes should be avoided. Products licensed for use on infants should be preferred. Barrier formulations ‘should ideally be fragrance free, preservative free, allow skin to breathe, easy to remove, antiseptic free and with proven clinical efficacy’.¹¹

Diabetes and pregnancy

Women with diabetes are at greater risk of having a larger baby or a miscarriage and their baby may be at risk of cardiac and respiratory problems as well as obesity and diabetes in later life. So it is important that diabetes is well controlled before a woman becomes pregnant to reduce risks. Referral to a GP, specialist nurse or diabetes clinic is therefore recommended as soon as a woman starts thinking about becoming pregnant. Changing treatment for diabetes and more regular blood glucose monitoring may be needed during pregnancy to maintain good control.^14,15

Pharmacies can offer advice on healthy eating, exercise and avoiding alcohol and not smoking – all of which can contribute to reducing risks for mother and baby.¹⁶

New type of pregnancy test

A pregnancy test that detects human chorionic gonadotropin in saliva rather than urine is planned to be launched by Abingdon Health this year. SalistickTM will be co-branded Abingdon Simply Test and will be sold through Abingdon’s direct- to-consumer eCommerce platform and through Abingdon’s other pharmacy distribution channels.¹⁷

Role for community pharmacies

The NPA’s Policy Manager, Helga Mangion, told Independent Community Pharmacist: ‘When a woman is expecting her first child, she might find herself in much more frequent contact with her community pharmacy than before.

‘Community pharmacies are there to provide support and advice to women before and after childbirth. They can help with the woman’s own health needs and that of babies on issues from feeding through to skin care.

‘Community pharmacists are also well placed to provide advice and support to people living with long-term conditions such as diabetes. This includes support to diabetic women during pregnancy, for example, with gestational diabetes. As well as advising on medication, pharmacists can discuss with patients ways to help control blood-sugar levels such as diet or taking more exercise.’

References

1. GOV.UK. Mental health and wellbeing: JSNA toolkit. Guidance: 4. Perinatal mental health (www.gov.uk/government/publications/better-mental-health-jsna-toolkit/4-perinatal-mental-health#fn:1; accessed May 2023).
2. National Institute for Health and Care Excellence (NICE). Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192] (www.nice.org.uk/guidance/cg192/chapter/Introduction; accessed May 2023).

3. National Institute for Health and Care Research (NIHR). Two simple questions help GPs rule out depression. (https://evidence.nihr.ac.uk/alert/two-simple-questions-help-gps-rule-out-depression/#:~:text=The%20two%20simple%20questions%20are,%3F%20%2D%20in%20the%20past%20month; accessed May 2023).
4. National Institute for Health and Care Excellence (NICE). Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192] (www.nice.org.uk/guidance/cg192/chapter/Introduction; accessed May 2023).

5. Sapra A, Bhandari P, Sharma S, et al. Using Generalized Anxiety Disorder-2 (GAD-2) and GAD-7 in a Primary Care Setting. Cureus 2020;12(5):e8224.
6. Royal College of Psychiatrists. Mental Health in pregnancy. www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/mental-health-in-pregnancy?searchTerms=Mental%20Health%20in%20Pregnancy; accessed May 2023). (www.medicines.org.uk/emc/rmm/1203/Document; accessed May 2023).
7. bumps (Best Use of Medicines in Pregnancy) (www.medicinesinpregnancy.org; accessed May 2023).
8. GOV.UK. Guidance: Valproate use by women and girls (www.gov.uk/guidance/valproate-use-by-women-and-girls; accessed May 2023).
9. Guide for Healthcare professionals. Information on the risks of Valproate use in girls (of any age) and women of childbearing potential (Epilim, Depakote, Convulex, Episenta, Epival, Kentlim, Orlept, Sodium Valproate, Syonell, Valpal, Belvo & Dyzantil). Prevent: valproate pregnancy prevention programme (www.medicines.org.uk/emc/rmm/1203/Document; accessed May 2023).
10. NHS.UK. Your newborn baby (www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/getting-to-know-your-newborn; accessed May 2023).
11. Thames Valley & Wessex Operational Delivery Networks. Guideline Framework for Neonatal Skin Integrity (www.piernetwork.org/uploads/4/7/8/1/47810883/skin_integrity_guideline-_dec_2019_final.pdf; accessed May 2023).
12. Royal Berkshire NHS Foundation Trust. Advice on skincare for newborn babies (www.royalberkshire.nhs.uk/media/t5jliy1a/skincare-advice-for-newborn-babies_sep20.pdf; accessed May 2023).
13. Johns Hopkins Medicine. Newborn skin 101 (www.hopkinsmedicine.org/health/wellness-and-prevention/newborn-skin-101; accessed May 2023).
14. NHS.UK. Diabetes and pregnancy (www.nhs.uk/pregnancy/related-conditions/existing-health-conditions/diabetes; accessed June 2023).
15. Diabetes UK. Planning for a pregnancy when you have diabetes (www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy; accessed June 2023).
16. Diabetes UK. Managing your diabetes during pregnancy (www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy/during-pregnancy; accessed June 2023)
17. Abingdon Health. Abingdon Health to launch the first ever saliva pregnancy test into the UK and Ireland (www.abingdonhealth.com/news/abingdon-health-to-launch-the-first-ever-saliva-pregnancy-test-into-the-uk-and-ireland/#:~:text=SalistickTM%20is%20a%20rapid,hormone%20β%2DhCG%20in%20saliva; accessed June 2023)