I'm not ill... I'm pregnant

I'm not ill - I'm pregnant, is a phrase most mothers have probably used during pregnancy. But pregnant women do suffer from everyday healthcare problems - from nasal congestion to headaches to upset stomachs to hay fever even nicotine cravings - in addition to pregnancy-induced ailments such as morning sickness, varicose veins and backache.

Many pregnant women prefer to avoid medication if at all possible but sometimes the discomfort of everyday healthcare conditions can make a normal, happy, healthy pregnancy a misery. So, which over-the-counter and nutritional remedies are safe and beneficial for pregnancy? The Consumer Health Information Centre (CHIC) and the Health Supplements Information Service (HSIS) have prepared a check-list for mums to be:

Congestion (coughs and colds)
Non-medicated pastilles containing honey/glycerol, boiled sweets and non-medicated hot drinks can help dry coughs and sore throats. Simple linctus can also be recommended for its short-term soothing effect. Steam inhalations can help to liquefy mucus resulting from chesty coughs and the inhalation of oil-based decongestants may also provide relief from congestion.

Headaches
Treatment for headaches is more or less restricted to paracetamol, which is generally regarded as safe to use in pregnancy. A massage can also help to alleviate headaches. Conversely, migraine attacks often improve during pregnancy.

Morning sickness
There are no over-the-counter medicines licensed for the treatment of morning sickness. In milder cases though, nausea may be controlled by eating small and frequent meals that are high in carbohydrates and low in fat. This will help to maintain blood sugar levels. Ginger and peppermint teas might also be worth considering and barley sugar, boiled sweets or peppermints can be helpful when travelling.

Heartburn and indigestion
Some antacid preparations are licensed for over the counter use in pregnancy. Calcium carbonate, which has the greatest neutralising capacity, or a combination of aluminium and magnesium salts, which are relatively insoluble and therefore persist for longer in the stomach, are probably the compounds to look out for in medicines.

Backache
As per headaches above, treatment for back pain is more or less restricted to paracetamol. Advice for minimising back pain includes: do not stand or sit in the same position for too long,; rest when pain is severe (lying with legs raised can be helpful), ;support the back with a pillow when sitting,; wear flat shoes, when picking up anything heavy, take the strain on the legs,; try gentle stretching to relax tight muscles, and soak in a warm bath.

Nicotine cravings
Women who smoke should be encouraged to stop, if possible. A pharmacist will be able to recommend a suitable nicotine replacement therapy (NRT) to take before pregnancy.

Constipation
The first treatment option should be to increase fluid intake and the amount of fibre in the diet. If this approach is unsuccessful, bulk-forming laxatives such as ispaghula husk or lactulose can be tried. One or two doses of the stimulant laxative, senna, can be taken if gentler laxatives fail. However, senna should probably not be used in the later stages of pregnancy because, theoretically, it can cause uterine contractions.

Haemorrhoids/piles
In mild cases a bland haemorrhoidal cream or ointment can be tried. Alternatively, an ice pack can be applied and a topical bland astringent preparation may also be recommended if necessary.

Thrush (Candidiasis)
Pharmacists, unfortunately, have no alternative but to refer patients to a doctor as antifungal treatments, available without prescription, are not licensed for sale to pregnant women.

Varicose veins
An increased intake of calcium and potassium has been recommended to reduce the incidence of leg cramps, although there is no evidence of effectiveness. Avoiding high-heeled shoes and putting a pillow at the foot of the bed to prevent stretching the foot forward are probably more effective measures. Massage and stretching of the affected muscles during an attack are the only form of relief that can be recommended.

Folate metabolism defect (folic acid)
'Neural tube defects' (abnormalities in the development of the neural tube - which forms the brain and spinal cord - in developing babies) - such as spina bifida - appear to be linked to a 'metabolic defect' in folate metabolism in the mother. This means that, even though the mother may have an adequate dietary intake of folic acid, her body cannot use it efficiently. Taking extra folic acid when the neural tube is forming can reduce the chance of the baby having a neural tube defect. Women are advised to take folic acid prior to conception and to continue taking folic acid supplements until the 12th week of pregnancy.

In addition, folic acid is essential for the formation of red blood cells and has been shown to reduce the levels of an amino acid (homocysteine). This reduction may have a protective effect against heart disease. In the UK, women who are planning or who may become pregnant are advised to take a supplement containing 400mcg folic acid every day. Women may also choose to eat a diet containing lots of fortified foods such as breakfast cereals and some breads and folate rich foods.

If you are thinking of taking any medicines during pregnancy, always consult your pharmacist or doctor first.

Always read the label.