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2017 HCHB_digital

Pregnancy Tests and

Pregnancy Tests and Supplements Home pregnancy tests detect the presence of human chorionic gonadotrophin (HCG) – a hormone produced by the placenta within six to 10 days of implantation of a fertilised egg – in a woman's urine. The level of this hormone increases rapidly from conception, doubling every one to two days until it peaks at around 10 to 12 weeks. It can be measured in the urine of a pregnant woman from at least the first day of a missed period, with some tests having the ability to measure it from as early as four days before an expected period, or seven days after conception. If instructions are followed correctly, home pregnancy tests are sensitive enough to provide a reading that is at least 99% accurate. Alcohol, pain-killers, antibiotics and oral contraceptives do not affect pregnancy tests. Some medicines, such as fertility drugs, can cause false-positive pregnancy test results. Traces of the HCG hormone may be found in urine for up to eight weeks after a miscarriage or termination, and for up to four weeks after the birth of a child. Home tests are also available to pinpoint the time of ovulation – the release of eggs from the ovaries (see Product options below). Fertility facts • Technically, a woman can only get pregnant during the five days before ovulation, up until the day of ovulation. This is called the "fertile window" and reflects the lifespan of sperm (five days) and the lifespan of the ovum (24 hours). • Women are most likely to get pregnant two days before ovulation and the day of ovulation. 12-24 hours after ovulation, the probability of pregnancy rapidly declines and pregnancy will not be possible during that cycle. • For women unaware of when their "fertile window" is, sexual intercourse is recommended every two to three days to optimise their chances of conceiving. • Age is the most important factor when it comes to conception. »» Women are most fertile between the ages of 16 and 25. »» At age 30, the chance of conceiving each month is around 20%. This declines to approximately 5% by age 40. »» The risk of pregnancy and birth complications, caesarean section, stillbirth, miscarriage and birth defects all increase with age. • Obesity also affects the chance of conception and having a healthy baby. PRODUCT OPTIONS Category Examples Comments Pregnancy testing Folic acid supplements Iodine Ovulation testing [GENERAL SALE] eg, Discover Onestep Early Result, EasyCheck Midstream Pregnancy Tests*, Pregnosis Early Pregnancy Test Dip & Read*, Pregnosis In- Stream Early Pregnancy Test* [PHARMACY ONLY MEDICINE] eg, folic acid (Apo-Folic 0.8, Blackmores Folic Acid) eg, folic acid with iodine, iron and other vitamins and minerals (Elevit with Iodine, Blackmore’s Conceive Well, FabFol) eg, folic acid with iron (Ferrograd F) [PHARMACY ONLY MEDICINE] eg, NeuroTabs (contains equivalent iodine 150mcg), Elevit with iodine (contains potassium iodine 250mcg), FabFol (contains equivalent iodine 150mcg) [GENERAL SALE] eg, EasyCheck Ovulation Kit*, Ovuplan 10 Day Pregnancy Planning Kit*, Ovuplan Scope* Follow the manufacturer’s instructions exactly as stated on the packet. Some test sticks are held in mid-stream urine, while others need a urine sample collected in a clean container, which is tested with a dip-and-read stick. Test urine samples immediately after collection. Some fertility drugs may give false-positive results. Folic acid taken one month before and three months after conception reduces the incidence of neural tube defects (eg, spina bifida). Women planning a pregnancy should take supplements containing 0.8mg of folic acid. Women at high risk of a neural tube defect (NTD) affected pregnancy (including spina bifida) may require more folic acid and should ask their GP for advice. This includes those who have previously had an NTD-affected pregnancy, have a family or personal history of NTD (or whose partner has a family or personal history), who are on insulin treatment for diabetes, or women taking medications known to affect folate metabolism (eg, carbamazepine, clomiphene, valproate, retinoids and etretinate). The NZ MOH recommends healthy pregnant and breastfeeding women take a daily 150mcg iodine-only tablet from confirmation of pregnancy until the discontinuation of breastfeeding in addition to eating iodine-containing foods such as low-fat milk products, eggs, seafood, and commercially prepared bread. Women with pre-existing thyroid disease or with currently high iodine intakes should be referred for further medical advice. Luteinizing hormone (LH) controls egg release. LH levels noticeably rise about 24–36 hours before ovulation. Home ovulation tests usually either measure LH in the urine, or oestrogen levels in saliva, and help to pinpoint the most fertile days in a woman’s cycle. Relieve leg cramps Crampeze Pregnancy Leg Cramps Contains magnesium, vitamin B6 and D, and viburnum opulus to assist with the relief of leg cramps during pregnancy and whilst breastfeeding. Natural / herbal products / supplements [GENERAL SALE] eg, Mumomega Pregnancy 30 Capsules*, Bio- Oil, Mustela Stretch Mark Double Action, ginger, horsetail, Lady's Mantle eg, Sea-Band Mama Mumomega capsules contain DHA-rich marine fish oils and evening primrose oil. Creams or oils applied twice daily from the first trimester of pregnancy may reduce the development of stretch marks. Ginger has been shown to alleviate nausea in pregnancy. Horsetail may help tone the uterus and Lady's Mantle may help prevent spot bleeding. Pressure applied to the Nei-Kuan acupressure point may help relieve morning sickness. Products with an asterisk have a detailed listing in the Pregnancy section of OTC Products, starting on page 255. Page 122 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION »» Diet can affect fertility in the short and long term. »» A healthy body mass index (BMI) of between 20 and 25 is required by most women to sustain ovulation. Obesity affects ovarian function and can lead to abnormal menstrual cycles. »» Weight loss and a significant lack of body fat are related to the cessation of ovulation. • Cigarette smoking decreases sperm count in men and increases the risk of miscarriage, ectopic pregnancy, and premature birth in women. »» Smokers are only 60% as likely to conceive each month as non-smokers. • Alcohol also affects sperm count and if taken during pregnancy can increase the risk of birth defects in babies. • Caffeine can detrimentally affect fertility if more then two cups of caffeinated drinks are drunk per day. • 60% of couples get pregnant within three months; this increases to 80% by six months. Most couples with relative infertility eventually conceive and only 5% have complete infertility. »» Around 30% of infertility is attributable to a problem with female fertility, 30% to a problem with male infertility, and in 20% there is a problem with both partners. No clear or definite cause is ever found for the other 20%. Supplements Folic acid should be taken at least one month before conception and three months after to reduce the incidence of neural tube defects in the developing baby (see Product options on opposite page). Iodine should be taken throughout pregnancy and while breastfeeding to support normal brain growth and development in the unborn baby and newborn infant. Pregnant women should also talk with their doctor or midwife about other supplements (eg, calcium, iron, vitamin D) that may also be needed during pregnancy. Pregnancy points • Breast changes (eg, fullness, tenderness) are often the first signs of pregnancy. The nipples also enlarge as pregnancy develops. • Shorter, lighter bleeding may occur during early pregnancy in some women, at the expected time of their period. • Certain foods (eg, cold meats, raw eggs, uncooked seafood, unpasteurised cheese/milk) are not recommended during pregnancy. See www.foodsmart. govt.nz for a list of safe foods in pregnancy. • Leg and foot cramps are common in pregnancy. Supplements may help. Initial assessment Discuss folic acid and iodine supplementation with any woman coming into the pharmacy for a pregnancy or ovulation test kit (see Product options opposite for more details). Women who are planning to conceive should also refrain from drinking alcohol, smoking cigarettes or other substances, and minimise caffeine intake. If a woman not been previously vaccinated against rubella (German measles), she should talk to their doctor about getting vaccinated before conception. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the woman have any other health conditions (eg, epilepsy, thyroid problems)? • Does the woman take any other medication or herbal remedy, either prescribed by a doctor or bought from a shop or supermarket? • Would the woman be worried if she was pregnant? • Has the woman missed a period but pregnancy tests have been negative? • Does the woman usually have irregular periods so is not quite sure when her next period is/was due? • Has the woman had a positive pregnancy test but has not yet seen a doctor? • Has the woman been having abdominal pain or period problems? • Does the woman have any allergies to supplements? Advise women who are pregnant to organise a lead maternity carer (LMC) as soon as possible – this can be a midwife or specialist doctor. See www. findyourmidwife.co.nz or ask your doctor for a local list of LMCs. Advice for customers • If the woman’s menstrual cycle varies in duration so that period dates cannot be predicted, test first thing in the morning when HCG concentration is at its strongest. Use a mid-stream urine sample. • Retesting after a few days is recommended if a women gets a negative result after using an early pregnancy test seven days post ovulation. » » Alternatively, blood tests (from a doctor) are sensitive at detecting HCG from about six to eight days after ovulation. • For more information on medications that can be safely taken during pregnancy see Drugs in Pregnancy, page 210. Page 123

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