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Vitamins and supplements and over the counter medicines

Vitamins and supplements and over the counter medicines

Close up of pregnant woman comparing pill bottle label with information on hand-held notes It is recommended that all women take folic acid and vitamin D supplements during pregnancy. You can buy these over the counter or alternatively ask your GP for a prescription. Folic acid can be stopped when you are 12 weeks pregnant, whereas vitamin D can be taken throughout pregnancy and whilst breastfeeding. Other vitamins are unlikely to be needed if you have a healthy and balanced diet. Some women find that their iron levels drop in pregnancy – you will be offered blood tests to see if you need any iron supplements. If you receive certain benefits you may be entitled to free vitamins from Healthy Start. Sometimes it is necessary to take medication in pregnancy, although this should always be on the specific advice of your midwife or doctor. In some circumstances, certain types of medications are recommended for over the counter purchase rather than requiring a prescription. The types of medications that fall into this category are: Antacids Laxatives Vitamins and minerals Iron supplements Analgesia (painkillers) Moisturisers and steroids Aspirin Treatment for haemorrhoids (piles), thrush, cold sores, dandruff etc. If your healthcare professional recommends that you take such medication you will be advised to see your local pharmacist, who will be able offer further advice and information about the recommended products.
Vitamins and supplements in pregnancy Healthy start Further guidance on vitamins and supplements in pregnancy
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Pre-existing conditions and pregnancy

Pre-existing conditions and pregnancy

It is important to tell your GP, obstetrician and/or midwife about any pre-existing physical or mental health conditions. This also includes any previous surgery (including cosmetic procedures) or any childhood conditions or health problems from which you have now recovered. This information helps the team assess if anything further is needed to keep you and your baby healthy during the pregnancy. If you are under specialist care for your medical condition, it is important that you speak to them and discuss any impact your condition may have on your pregnancy. Ask them for a summary and for this to be written in your antenatal notes. Notes don’t automatically move between maternity units and/or departments, so don’t assume that your midwife or doctor knows what your previous carers have said or recommended. If you would like more information, please use the links below to check the safety of your medication in pregnancy. Conditions we need to know about early (before 12 weeks) include:

Chronic hypertension and other medical conditions that may increase the risk of you developing blood pressure concerns in pregnancy

Women with chronic hypertension and certain medical conditions are at a high risk of developing pre-eclampsia and will be prescribed low dose aspirin from 12 weeks. This includes any one of the following high risk factors:
  • Chronic hypertension.
  • Pre-eclampsia during a previous pregnancy.
  • Chronic kidney disease, diabetes, or an inflammatory disease, eg, Systemic Lupus Erythematosus (SLE).
Or more than one of the following moderate risk factors:
  • First pregnancy.
  • Maternal age over 40.
  • Last pregnancy was more that 10 years ago.
  • Body Mass Index (BMI) of 35 or more.
  • Family history of pre-eclampsia.
  • Expecting more than one baby in this pregnancy.

Thyroid disease

Hypothyroidism (under active thyroid)

As soon as you are pregnant, it is usually recommended that your Levothyroxine dose is increased by 25-50 mcg daily. You should then also contact your GP to arrange blood tests.

Hyperthyroidism (overactive thyroid)

You must discuss your plans for pregnancy with your endocrinologist to assess your disease status and the safety of the medications you are taking.

Epilepsy

Pregnancy may affect your seizures or the effect of your medication. If you become pregnant without having had a chance to discuss your medication(s), it is recommended that you see your GP or specialist as soon as possible. Prior to this review, keep taking your anti-epileptic medicines as normal. Certain medications may need to be stopped and changed to an alternative before you become pregnant, or as soon as possible if you’re already pregnant, due to the risks they pose to your baby. Some other medications need to be increased. Your doctor will prescribe a higher dose of folic acid supplementation (5mg per day).

Mental health and wellbeing concerns

It is understandable to worry about the effects of some medicines used to treat mental health conditions and concerns, but it is important not to stop taking your medications without speaking to your GP or specialist. This may lead to withdrawal symptoms, especially if stopped abruptly, could cause a recurrence of your symptoms or make your condition worse.

Diabetes

Women with Type 1 and 2 Diabetes should aim to have tight control of their diabetes prior to and throughout the pregnancy to reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. Pregnancy typically places higher demand for insulin than normal and so close monitoring and control of diabetes is important.

Crohn’s Disease, Ulcerative Colitis and other forms of Inflammatory Bowel Disease (IBD)

It is important to keep Crohn’s or colitis under control during pregnancy and you should not stop taking any of your medications unless your IBD team has advised you to do so. The risk from most medication is lower than the risk of a flare up.

Pregnancy with a heart condition

Women with known heart conditions need a referral to the specialist maternity services as soon as possible in early pregnancy and ideally would have had some pre-pregnancy counselling before trying for a pregnancy. This is because some heart conditions can increase the risk of complications in pregnancy and some medications may need to be stopped or adjusted. Please do not stop, or change, any medications without medical advice. If you would like more information, please use the link below to check the safety of your medication in pregnancy.
Pregnancy and baby guide Thyroid disease and pregnancy Epilepsy and pregnancy More on epilepsy and pregnancy Mental health and wellbeing concerns Mental health and wellbeing concerns and COVID-19 Diabetes and pregnancy Crohn’s Disease, Ulcerative Colitis and other forms of inflammatory bowel disease Pregnancy and heart disease Pregnancy with a heart condition Medicine in pregnancy
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After 37 weeks gestation/When expecting labour

After 37 weeks gestation/When expecting labour

Heavily pregnant woman making a mobile phone call Call the maternity unit you are booked at if you have:
  • heavy vaginal bleeding (more than a mucus show)
  • a reduction or change in your baby’s movements
  • contractions that are becoming strong and regular in pattern
  • abdominal pain that is constant
  • water leaking from the vagina, waters breaking
  • feeling unwell or worried something is wrong
  • high fever (temperature over 37.5ºC)
  • diarrhoea and/or vomiting combined with high fever, stomach pain, very dark urine or blood in the stools
  • headache accompanied by bad swelling in the hands, feet or face and/or problems with vision
  • itching on the hands or feet.
Contact my maternity unit
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After 18-20 weeks gestation

After 18-20 weeks gestation:

Worried-looking woman making a mobile phone call Call your GP or attend your local urgent care centre if:
  • any non-pregnancy related concerns, such as skin concerns or a persistent cough
  • pain or burning on passing urine
  • flare-ups of any pre-existing conditions
  • unusual vaginal discharge or discomfort
  • diarrhoea and/or vomiting for over 48 hours.
Call your maternity triage at the maternity unit you are booked at if you have:
  • vaginal bleeding
  • a reduction or change in your baby’s movements
  • high fever (temperature over 37.5ºC)
  • water leaking from the vagina
  • itching on the hands or feet
  • diarrhoea and/or vomiting combined with high fever, stomach pain, very dark urine or blood in the stools
  • headache accompanied by bad swelling in the hands, feet or face and/or problems with vision
  • moderate/severe abdominal pain that is either constant or comes and goes.
Explore maternity units
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Before 18-20 weeks gestation

Before 18-20 weeks gestation

Close up of women's hands using a mobile phone Call your GP or attend your local urgent care centre if:
  • your have a high fever (temperature over 37.5ºC degrees)
  • pain or burning on passing urine
  • flare-ups of any pre-existing conditions
  • repeated vomiting or diarrhoea with difficulty in keeping fluids down
  • any non-pregnancy related concerns, such as skin concerns or a persistent cough
  • spotting or light vaginal bleeding.
Call your local Early Pregnancy Unit or attend your Accident & Emergency Department if:
  • you have heavy bright red vaginal bleeding
  • moderate/severe abdominal pain.
Contact my maternity unit
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Having twins or triplets

Having twins or triplets

Pregnant woman holding two pairs of baby shoes across her pregnancy bmup Finding out you are having more than one baby can be exciting and special, but also sometimes overwhelming. All multiple pregnancies have a higher risk of complications, and therefore you will have extra appointments and scans to make sure you and your babies are well. If your babies share a placenta, it will be recommended that you have scans every two weeks, and if they each have their own placenta scans will be every four weeks. You are likely to have your babies earlier than 40 weeks.  Many twins are born vaginally although it may be recommended that they are born by caesarean section. You will have plenty of support from your maternity team throughout pregnancy, birth and beyond.
Twins and Multiple Births Association Multiple Birth Foundation Further guidance on multiple births
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Ultrasound scans

Ultrasound scans

Ultrasound screen close up of baby's head It’s important to remember that scans are another kind of test to confirm the health of your baby. Ultrasound is a medical examination. Sonographers need to be able to concentrate and as such it is not recommended that young children attend. You will normally be offered two scans in pregnancy. The first is known as the dating scan at around 12 weeks of pregnancy and the second (sometimes called the anomaly scan) is performed at around 20 weeks gestation. This second scan will look in detail at your baby’s bones, heart, brain, spine, face, kidneys and stomach. It is important to remember that the scan cannot find everything that could be of concern about your baby. The quality of the images depends on several factors, including body mass index and fibroids. If you wish to know the sex of your baby, you can ask the sonographer, although it isn’t always possible to see clearly. All pregnant women in the UK are offered antenatal screening tests. A screening test in pregnancy cannot give you a yes/no answer as to whether your baby has a condition. It can only tell you what the chances are of your baby being affected. Screening tests in pregnancy include blood tests and ultrasound scans (ultrasound scans can suggest there might be a condition (as in screening for Down’s syndrome) or confirm there is a condition (as in diagnosing spina bifida)).
  • Results are most often reported as a statistical chance and sometimes the terms “increased chance” or “low chance” will be used.
  • The terms “risk” and “chance” refer to the possibility of an event happening. For example, a chance of 1 in 100 means that out of 100 women with this result, 1 will have a baby with a syndrome and 99 will not. This is the same as a 1% chance that the baby has a syndrome and a 99% chance that the baby does not.
  • Most women will be reassured by the results but some (approximately 5%) will be given a result that leads to decisions about diagnostic testing. It is your choice to have any test.
  • Diagnostic tests such as CVS and Amniocentesis carry a small risk (between 0.5 and 1%) of miscarriage which means the decision about whether to have them can be difficult. Unfortunately, there is no other way of knowing for sure whether your baby has Down’s syndrome and certain other genetic disorders.
  • A diagnostic test in pregnancy can tell you for definite whether your baby has a condition or not. Diagnostic tests in pregnancy include CVS, amniocentesis and ultrasound scans.
  • All tests should be fully explained to you by your doctor or midwife before you have them.
The results of your scan will be given to you on the day by the sonographer completing the scan. Most maternity units will provide you with scan pictures at a small cost.
Dating scan  Anomaly scan  Fetal anomaly screen programme handbook
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Screening tests for chromosomal anomalies

Screening tests for chromosomal anomalies

Microscope close up of chromosomes A screening test can find out if you, or your baby, have a high or low chance of having a health problem. Inside the cells of our bodies there are tiny structures called chromosomes. These chromosomes carry the genes that determine how we develop. You will be offered a screening test to see how likely it is that your baby will have a abnormality in their chromosomes (Down’s, Edward’s or Patau’s syndrome). This test can be performed between 11 and 20 weeks and involves you having an ultrasound scan and a blood test. These tests are time critical, so it is very important that you attend for your scheduled appointment. If you are unable to attend contact the ultrasound department to rearrange as soon as possible. There are several different testing options available, so it is worth researching this early on. You will be contacted by the maternity unit if the results come back as high risk and you will be offered further testing. You do not have to have any testing if you don’t want to.
Screening tests for you and your baby Amniocentesis and chorionic villus sampling tests
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Antenatal appointments schedule

Antenatal appointments schedule

Midwife measuring pregnant woman's bump with a tape measure Once referred to a hospital, you can expect to see a midwife between 8 to 10 weeks of pregnancy. If your pregnancy is straightforward, these are the appointments you should expect to have. Certain medical or pregnancy needs may result in you needing more appointments than this. Appointments will normally be with a midwife, GP or obstetrician. The appointments at 25, 31 and 40 weeks are extra appointments for women having their first baby. At every appointment your midwife will ask you about how you are feeling, and give you the opportunity to ask any questions or raise any concerns you might have. You can bring your partner, friend or family member to your antenatal appointments. However, the midwife may request to see you alone for at least one appointment during your pregnancy.
Booking appointment (8-12 weeks) Dating scan (11-14 weeks) 16 weeks Anomaly scan (18-21 weeks) 25 weeks (first pregnancy only) 28 weeks 31 weeks (first pregnancy only) 34 weeks 36 weeks 38 weeks 40 weeks (first pregnancy only) 41 weeks
Screening tests and ultrasound scans