A woman comes to the counter.Her pregnancy notes are poking out of the top of her bag, and she looks upset.
"I've just had my 28-week appointment with the midwife," she says. "They're great at taking your blood pressure and talking about whether to have your baby at home or in hospital, but pretty useless on the here and now. I tried to ask her about my constipation and indigestion, but she was in too much of a hurry and just wasn't interested at all. You're supposed to be glowing when you're pregnant, but I feel terrible! Can you help me?"
Can you tell me?
1 What advice can you provide to this woman about her constipation?
2 Can she take anything for indigestion?
What OTC says
1 Constipation is very common in pregnancy, both early on because of hormonal changes and in the later stages as the growing baby starts pressing on the mother's internal organs.
The first thing to check with this patient is whether she is taking any medication. Iron tablets, prescribed during pregnancy for anaemia, are a common cause of constipation, and simply suggesting the patient asks for a different brand may solve the problem.
The next step is to recommend a number of lifestyle changes that help prevent constipation. These include eating more high fibre foods (such as wholegrain cereals, wholemeal bread, fruit and vegetables), taking regular gentle exercise to keep muscles toned, and drinking plenty of water (see p16 for full details). If these measures do not – or only partly – work, a laxative may be needed.
The osmotic laxative lactulose is commonly used during pregnancy as it is not absorbed by the body and so does not affect the growing baby, but as the customer is pregnant you should refer her to the pharmacist. You can find out more about osmotic laxatives on p18.
2 Like constipation, indigestion during pregnancy is caused by changing hormone levels and – later on – by the growing womb pressing on the stomach.The symptoms, which normally include burping and feeling full and sick, are more common after meals. The sphincter muscle at the top of the stomach also becomes more relaxed, which means that stomach acid leaks into the oesophagus and causes a burning sensation (often referred to as heartburn). This is often particularly bad at night when the woman lies down to go to sleep.
Lifestyle changes that can ease indigestion symptoms include eating more frequent and smaller meals, avoiding fatty or spicy foods, eating several hours before going to bed, and propping up the head of the bed with pillows to avoid lying down flat. Drinking milk can help ease heartburn, or there are several indigestion remedies (generally those containing antacids and/or alginates) that are suitable for use during pregnancy.
It is worth checking the sodium content of any indigestion remedies that you recommend, as pregnant women with high blood pressure should avoid excess sodium intake.
Only indigestion products that are clearly labelled as suitable for use during pregnancy should be sold and customers should be reminded to adhere to the dosing instructions, and to allow two hours between taking the product and any iron supplement they may be using. If OTC remedies do not work, the GP can prescribe an acid-suppressing agent, such as ranitidine or omeprazole.