Preparing for Pregnancy

I'm in my early 30s so have lots of friends and family who are starting or expanding their families with babies. It's an exciting time in life and so lovely when we get to meet the bubs and watch them grow into little people. There are so many things to consider when having a child. I thought I'd focus on some of the things you can do to best medically prepare yourself and your body for pregnancy.

Firstly, it's a good idea to see your family doctor for a medical check-up. This is particularly important if you are taking any medications as they can cross the placenta into the baby. Some medications are safe, some should be used with caution and some should not be taken at all during pregnancy. By discussing your medications with your doctor before you start trying to become pregnant, you can weigh up the risks and perhaps even change to a medication known to be safe with plenty of time. Don't forget to mention over-the-counter medications and herbal or complementary medicines as these can also affect your baby.

You should also discuss immunisations with your doctor. If you are unsure about what immunisations you have had, you can organise blood tests to check your immunity status. It is important that you are fully immunised against chicken pox, influenza, measles, mumps, rubella, diphtheria, tetanus and whooping cough. If you require any 'live' vaccines such as measles, mumps, rubella or chicken pox, you should wait one month before trying to become pregnant. It is also a good time for any other people who live with you to update their immunisations too as this will reduce the risk of these diseases being passed on to your baby.

It is recommended that women who are intending to become pregnant take 0.5mg of folic acid for one month before pregnancy and at least the first three months during pregnancy. Folic acid has been proven to reduce to risk of neural tube defects such as spina bifida. Some women, such as those with a family history of spina bifida or cleft palate or are taking medication for epilepsy, are recommended to take higher doses. Once again, speak to your doctor.

Some women choose to take a multivitamin either before and/or during pregnancy. Discuss this with one of our pharmacists at Berwick Pharmacy as excess amounts of certain vitamins such as Vitamin A can actually be harmful to your baby.

Iodine is a mineral which helps with the development of the thyroid hormone. Iodine is found is most breads as well as eggs, meat, dairy and seafood. It is also in some pregnancy multivitamins. Women who are pregnant should switch to iodised salt (rather than uniodised salt) when cooking.

No completely safe level of alcohol consumption has been determined for pregnant women. Many women choose to abstain from alcohol completely and some will allow the occasional drink. Keep in mind that there is a higher risk if alcohol is consumed early in the pregnancy, including the time prior to the first missed period. Speak to your family doctor or obstetrician with any concerns.

If you are a smoker, it's the perfect time to quit. Smoking can increase your risk of miscarriage and stillbirth and babies of mothers who smoke are at a higher risk of low birth weight, being born prematurely and Sudden Infant Death Syndrome (SIDS). Our pharmacists at Berwick Pharmacy can discuss options with you to help you to quit.

It's wise to limit your caffeine intake if you are trying to become pregnant as there is evidence that it can decrease fertility. Don't forget that caffeine is also present in some soft drinks and energy drinks. Guarana, an ingredient also often in energy drinks, is not recommended during pregnancy.

If you are pregnant, you also need to be aware of the potential risk of Listeria and Salmonella infection. The risk of catching these bacteria is small, but it can be dangerous if it passes to your baby. Always practice good food handling hygiene and if you are eating reheated food such as leftovers, make sure it is piping hot. Avoid foods such as soft cheeses, cold cooked chicken or deli meats, whole egg, pate, soft serve ice-cream and raw seafood.

It's also worth having a dental check-up prior to becoming pregnant as generally, procedures such as x-rays aren't recommended during pregnancy. If you are planning on having your baby in a private hospital, you should also check your level of health insurance and make sure you are aware of any waiting periods.

So yes, there's lots to think about, but by doing some groundwork in advance, you're giving yourself, and your baby, the best start to life. Pop into Berwick Pharmacy anytime for advice on pregnancy or any other

health issues. We even sell home pregnancy tests for when the time comes.

Here's a cute cartoon I found...

References and further reading

• Immunisation and Pregnancy Fact Sheet, Better Health Channel, published July 2011 (accessed online 22 March 2012)
• Pregnancy and Drugs Fact Sheet, Better Health Channel, published March 2010 (accessed online 22 March 2012)
• Preparing for Pregnancy - Your Health Fact Sheet, Royal Women's Hospital, published January 2008 (accessed online 22 March 2012)
• Food Safety During Pregnancy Fact Sheet, Royal Women's Hospital, published January 2012 (accessed online 22 March 2012)

Safety of Medicines in Pregnancy and Breastfeeding

When I was pregnant with The Munchkin, I was lucky enough to have a pretty uneventful pregnancy. I never got morning sickness, I didn't have too much by way of sleep disturbances, I felt pretty energetic throughout. As I said, very lucky. Pretty much the only weird thing I had was the occasional urge to dry retch when I brushed my teeth. Weird, right?

There were times when I almost forgot I was pregnant, and was only reminded when I looked down at my ever-growing belly. But when you are pregnant, there's suddenly a whole bucketload of new things you need to think about, and not just in relation to decorating the nursery.

It would be lovely to think that pregnant and breastfeeding women never get sick and never need any medications, but unfortunately, this is just not the case. Long-standing conditions such as asthma and epilepsy still require treatment during pregnancy and breastfeeding. Then there's the usual bugs and viruses that we are all still susceptible to. And don't forget that we are not just talking about prescription medications. There's also medications that you buy over-the-counter at your pharmacy and herbal and complementary products. Even medications that are in creams or ointments, in nasal sprays or eyedrops or patches can be passed across to your baby.

Medications taken by pregnant women can pass across to the baby via the placenta, just as the baby receives nutrients. Some medications can actually affect baby's development or cause miscarriage.

In addition, medications taken by breastfeeding women can pass across to the baby via the breastmilk. This may cause baby to have symptoms of drowsiness, difficulty settling, cause vomiting or diarrhoea or may affect baby's suckling reflex, making feeding difficult.

So how do we know what is safe and what isn't? This question is slightly more complicated than you would expect.

As a general rule, pharmaceutical companies don't test their medications in pregnant or breastfeeding women. For that reason, pharmaceutical companies are usually reluctant to emphatically state their medications are safe. Information about the potential safety of medications in pregnancy and breastfeeding is usually extrapolated from studies in animals such as mice. There are, however, groups worldwide which collate information and look for trends and your pharmacist and doctor will be able to access this information for you.

Some general rules which can help if you do need to take medications whilst pregnant or breastfeeding are:

• Always remind your doctor and pharmacist you are pregnant or breastfeeding so they can check the safety of any medications. Don't forget to mention over-the-counter and herbal products.
• Consult your doctor or pharmacist before suddenly stopping any medications.
• If you are on long-term medication and planning to start a family, discuss this with your doctor and pharmacist before getting pregnant. It may be wise to switch to another medication which is safer in pregnancy.
• If you do need to take a medication whilst breastfeeding, chat to your pharmacist about the best time of day to take it and keep a close eye on baby for any adverse effects (e.g. drowsiness, irritability, change in bowels).
• Limit or avoid alcohol if pregnant or breastfeeding. Click here for a leaftlet produced by the Australian Breastfeeding Assocation titled "Alcohol and Breastfeeding: a guide for mothers".
• Limit or avoid caffeine (coffee, tea, cola, energy drinks).
• Avoid recreational drugs.
• If you are a smoker, there's never been a better time to quit! For more advice on quitting, pop into Terry White Chemists Berwick for a chat with our pharmacists and ask for our Self Care card on Smoking. Quit Victoria also has a great website with heaps of information and advice.

The best advice to always discuss any concerns about your medications with your doctor (and obstetrician if you have one) and pharmacist. Our pharmacists at Terry White Chemists Berwick would be pleased to have a chat about any health-related issues, including those related to pregnancy and breastfeeding. They will be able to look at the appropriate references and help guide you towards what is safest for you and your baby.


References and further reading

• Medicines and Breastfeeding Self Care Card, Pharmaceutical Society of Australia, published July 2008
• Smoking Self Care Card, Pharmaceutical Society of Australia, published February 2010
• The Royal Women's Hospital Victoria website
• Quit Victoria website
• Australian Breastfeeding Assocation website
• Pregnancy and Drugs Fact Sheet - Better Health Channel, published October 2009 (accessed online 3 September 2011)
• Pregnancy and Smoking Fact Sheet - Better Health Channel, published February 2010 (accessed online 3 September 2011)

Cancer and Daffodil Day

This Friday, 26^th August is Daffodil Day in Australia. Daffodil Day is the largest fundraising event of its kind in the Southern Hemisphere and aims to raise much-needed funds for cancer research, prevention and support services. It is run by the Cancer Council of Australia and this year they are celebrating 25 years of Daffodil Days. That’s a lot of daffodils!

The bright, sunny, yellow daffodil is the international symbol of hope for all those touched by cancer, and at this time of the year, daffodils are such a welcome sight after the cold, drab, grey months of Winter.

Cancer is a word which strikes absolute fear into the hearts of pretty much everyone. I don’t think there would be an Australian who hasn’t been affected by cancer in some way, whether it’s through personal experience or that of a family member, friend or colleague.

What are the facts? Well, last year in Australia alone, it is estimated that there were 114,000 new cases of cancer diagnosed. 1 in 2 Australians will be diagnosed with cancer by the age of 85. Cancer is a leading cause of death in Australia, with over 43,000 people dying from cancer in 2010. The most common cancers in Australia (excluding non-melanoma skin cancer) are prostate, colorectal (bowel), breast, melanoma and lung cancer.

Cancer does seem to be on the rise when you compare current figures with those from years ago, but this is largely due to population growth, ageing and improvements in screening and diagnosis. Despite the increase in the number of cancer deaths, the actual proportion of patients who die from cancer has fallen by 16% in the past 30 years.

The other good news is that the survival rate for many common cancers has increased by 30% in the past twenty years. More than 60% of cancer patients will survive more than five years after diagnosis.

Having worked as a pharmacist in a Chemotherapy Day Unit (a ward where patients are admitted for the day just to receive their chemotherapy), it is a fascinating, complex and incredibly busy area of the hospital. It would be impossible for me to cover everything about cancer in the one blog post, but I thought I'd give a brief summary on screening and treatments.

Cancer Screening

Clearly, it is much easier to treat a cancer if it is diagnosed in the early stages of disease. This is where the importance of screening lies. There are currently three national population-based cancer screening programs operating. These are:

• BreastScreen Australia Program - an x-ray of the breast (called a mammogram) is performed every two years to screen for early signs of breast cancer in women aged 50-69 years. Women should also check their own breasts for any changes each month.

• National Cervival Screening Program – a doctor takes a Pap Smear which is used to take a tiny sample of cervical cells to detect changes in the cervix which may lead to cervical cancer in women. Pap Smears should be done every two years either from the age of 18 years old or one or two years after sexual activity starts, whichever is later.

• National Bowel Screening Program – this involves placing a small sample of your stool on a special card in the privacy of your own home and sending the card to a laboratory for analysis. The test looks for the presence of blood in your stool which can be an early warning sign of bowel cancer. If you are turning 50, 55 or 65 between January 2011 and December 2014, the government will automatically arrange for a free test to be posted to you around your birthday. If not, BowelScreenAustralia™ test kits are available for purchase at Terry White Chemists Berwick and Terry White Chemists Eden Rise as well as many other pharmacies. Click here to find a pharmacy that sells the test kits near you.

Cancer Treatments

There are three main treatments for cancer and these can be used either on their own or in combination.

The first is surgery where the tumour itself and surrounding tissue is removed. This is used when the tumour is small and contained to one area.

The second option is radiotherapy which is where precisely targeted x-rays are used to destroy cancer cells. The length of treatment depends on the type, size and location of the tumour(s), but most patients have five treatments a week for a few minutes each time, for one to seven weeks.

The third option, and probably the one that most comes to mind when people hear think about treating cancer, is chemotherapy. Chemotherapy is the use of cancer-killing medicines which can be given in tablet or capsule form or, more commonly, straight into the bloodstream by an infusion (i.e. a drip). There are many different chemotherapy medicines and different doses and combinations are given depending on factors such as the type of cancer involved.

Chemotherapy is incredibly good at destroying cancer cells, but unfortunately, it can also harm healthy cells too which can lead to side effects such as fatigue, nausea, vomiting, mouth ulcers and loss of appetite. We often hear patients voice concerns about hair loss with chemotherapy, but this is dependent on the particular chemotherapy medications that they receive. Your doctors and pharmacists will try to work together to minimise these side effects, perhaps by giving you other medications. Patients should speak to their oncologist, family doctor and pharmacist about any worries they have regarding chemotherapy and any side effects.

We often have queries from patients regarding the safety and efficacy of complementary and alternative cancer treatments. Some treatments are perfectly safe to use and can help you to feel better, but others may interfere with your cancer treatment and should not be used. Always check with your pharmacist or doctor before taking non-prescribed medications, even if they are “natural”. The Cancer Council Victoria has a free book called Complementary and alternative cancer therapies which can be downloaded here.

How Can You Help?

Cancer really is a huge subject and one that needs awareness and public support. So this Friday, do your part and pop into Terry White Chemist Berwick or Terry White Chemist Eden Rise, Coles supermarket or another authorised seller and pick up a badge, teddy bear, pen or bunch of daffodils and feel good that you’re helping researchers find a cure for cancer.

References and further reading

• Cancer Council Australia website
• Cancer Council Victoria website
• Bowel Cancer Australia website 
• Peter MacCallum Cancer Centre website
• The Royal Children's Hospital Melbourne website

• Cancer Fact Sheet, Better Health Channel, published November 2010 (accessed online 23 August 2011)

• Cancer Screening Fact Sheet, Better Health Channel, published December 2010 (accessed online 22 August 2011)
• Cancer Treatments - Chemotherapy Fact Sheet, Better Health Channel, published November 2009 (accessed online 22 August 2011) 
• Cancer Treatments - Radiotherapy Fact Sheet, Better Health Channel, published August 2009 (accessed online 22 August 2011)