Long-term health conditions and medications in pregnancy

Long-term health conditions

Long-term health conditions, also known as chronic conditions, can have a major impact on fertility, pregnancy, and the health of both the mother and child.

If a person has a chronic condition like diabetes, hypertension (high blood pressure), or asthma, managing it before pregnancy is key to improving health outcomes.

Advise them to work with their healthcare provider to ensure their condition is under control before they conceive.

Managing long term conditions

Managing these conditions before becoming pregnant is key to improving health outcomes.

Messages for healthcare professionals to share

• contact healthcare early - advise anyone with a long term health condition to contact their doctor or midwife as soon as they can
• plan ahead - for those planning pregnancy, it's essential to manage chronic conditions like diabetes, hypertension, or asthma before conceiving - encourage them to work with their healthcare provider to ensure their condition is under control
• medication safety - advise patients to consult their doctor or healthcare provider about the safety of their medications during pregnancy. They should not stop any medications without medical advice

For further information, visit the East Midlands Maternal Medicine Network for more details on pre-pregnancy care.

Vitamins, supplements and nutrition

Eating a healthy, varied diet will help you get most of the vitamins and minerals you need. But when you're pregnant or there's a chance you might get pregnant, it's important to also take some specific supplements.

Do not take cod liver oil or any supplements containing vitamin A (retinol) when you're pregnant. Too much vitamin A could harm your baby. Always check the label.

You also need to know which foods to avoid in pregnancy.

Folic acid before and during pregnancy

It's important to take a 400 micrograms folic acid tablet every day before you're pregnant and until you're 12 weeks pregnant.  Folic acid can help prevent birth defects known as neural tube defects, including spina bifida.

If you did not take folic acid before you conceived, you should start as soon as you find out you're pregnant.

Try to eat green leafy vegetables which contain folate (the natural form of folic acid) and breakfast cereals and fat spreads with folic acid added to them.

It's difficult to get the amount of folate recommended for a healthy pregnancy from food alone, which is why it's important to take a folic acid supplement.

Higher-dose folic acid

If you have a higher chance of your pregnancy being affected by neural tube defects, you will be advised to take a higher dose of folic acid (5 milligrams). You will be advised to take this each day until you're 12 weeks pregnant.

You may have a higher chance if:

• you or the baby's biological father have a neural tube defect
• you or the baby's biological father have a family history of neural tube defects
• you have had a previous pregnancy affected by a neural tube defect
• you have diabetes
• you take anti-epilepsy medicine
• you take anti-retroviral medicine for HIV

If any of this applies to you, talk to a GP. They can prescribe a higher dose of folic acid. A GP or midwife may also recommend additional screening tests during your pregnancy.

Find out about epilepsy and pregnancy.

Vitamin D in pregnancy

You need 10 micrograms of vitamin D each day. It's recommended that pregnant and breastfeeding women take a daily supplement containing this amount between September and March.

Vitamin D regulates the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy. Our bodies make vitamin D when our skin is exposed to summer sunlight (from late March / early April to the end of September)

Between the months of September and March the body cannot make sufficient vitamin D from sunlight alone, which is why a supplement is recommended.

Vitamin D is also in some foods, including:

• oily fish (such as salmon, mackerel, herring and sardines) – during pregnancy, you should eat no more than 2 portions of oily fish a week
• egg yolks
• red meat
• fortified foods – such as some fat spreads and breakfast cereals
• liver – but avoid eating liver during pregnancy

Because vitamin D is only found in a small number of foods, whether naturally occurring or added, it is difficult to get enough from foods alone.

Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful.

You can get vitamin supplements containing vitamin D free of charge if you're pregnant or breastfeeding and qualify for the Healthy Start scheme.

Where to get pregnancy supplements

You can get supplements from pharmacies and supermarkets, or a GP may be able to prescribe them for you.

If you want to get your folic acid from a multivitamin tablet, make sure the tablet does not contain vitamin A (or retinol).

You may be able to get free vitamins if you qualify for the Healthy Start scheme.

Resources

Derby Integrated Family Health Service has lots of advice to support a healthy pregnancy.

Health, exercise and nutrition for the really young (HENRY) HENRY is a unique intervention to support parents and carers to give their child a healthy, happy start in life.

Livewell Derby is Derby City Council’s healthy lifestyle service. The scheme provides free support to adults and children for up to 12 months to help them lose weight, become more active, quit smoking and improve their health.

Healthy Start, If someone is more than 10 weeks pregnant or has a child under 4, they may be entitled to get help to buy healthy food and milk.

Medications and preconception care

People with chronic conditions often take medications that may not be safe during pregnancy.

Reviewing and adjusting these medications is a crucial step in preconception care.

Messages for healthcare professionals to share

• medication review - before trying to conceive, individuals should review all medications (including their partner's) with their healthcare provider to ensure they are safe for pregnancy - some medications may need to be changed or adjusted to lower the risk of birth defects or complications
• do not stop medication without advice - patients should be advised not to stop taking any medications without consulting a healthcare professional

Genetics and preconception health

Some health conditions can be inherited. People with a personal or family history of genetic conditions may benefit from genetic screening and counselling to better understand how genetics could affect their fertility and the health of their future children.

Messages for healthcare professionals to share

• genetic screening - encourage individuals with a family history of inherited conditions to seek guidance from their doctor or consultant - genetic screening and counselling may be recommended for those at risk.

Neural tube defects (NTDs)

NTDs are serious birth defects of the brain, spine, or spinal cord that occur early in pregnancy, often before people know they are pregnant. These defects come from the improper closure of the neural tube during embryonic development.

Messages for professionals to share

• folic acid - it is recommended women, and pregnant people should take 400 micrograms of folic acid daily as it can prevent serious birth defects of the brain and spine
• it's important to start taking folic acid every day at least a month before planning to get pregnant

Folic acid is used to:

• treat or prevent folate deficiency anaemia
• help your baby's brain, skull and spinal cord develop properly in pregnancy, to avoid development problems such as spina bifida

Folic acid is the synthetic version of the vitamin folate, also known as vitamin B9. Folate helps the body make healthy red blood cells and is found in certain foods.

Read more on the NHS website about folic acid.

Healthy Start vitamins (containing folic acid and vitamin D) are available for pregnant women and people through the Healthy Start scheme.