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Getting pregnant Pharmacy assistant’s education Module 232
Getting pregnant
By Lynn Greig
This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.
Pharmacy assistants can play
an important role in providing
advice to women who are
planning to become pregnant.
They can suggest strategies
to help a woman increase her
chances of becoming pregnant
and having a healthy baby. They
can also provide information
about home pregnancy tests.
Pharmacy assistants should
be aware of the importance of
asking women of reproductive
age whether they are pregnant,
or planning to become pregnant,
when supplying Pharmacy only
medicines.
Vitamins and minerals are particularly important for women planning to become pregnant.
The menstrual cycle
Womens Health 3333
2011
Pregnancy and
Ovulation
To become pregnant, a woman needs to have sexual intercourse during the
fertile phase of her menstrual cycle. Her fertile phase occurs just before and on
the day of ovulation. A woman can find her day of ovulation by using a home
ovulation test. She can also test for pregnancy by using a home pregnancy
test. Pharmacists can give advice about these tests.
The menstrual cycle
A woman’s menstrual cycle begins on
the first day of her period (first day of
bleeding), and ends on the day before
her next period starts. Menstrual cycles
are usually between 21 and 40 days
long. Only about one in ten women
have a 28-day cycle. For some women
the length of their cycle (and the day
of ovulation) varies each month, while
others have a more regular cycle. Even
when a woman’s cycle is regular, the day
of ovulation may vary each month.
There are four main phases of the
menstrual cycle, which are controlled by
hormones. These phases are:
Menstruation (bleeding or period):
The thickened lining of the uterus
(womb) comes away from the uterus
wall, and the blood and tissues pass out
through the vagina. A period usually
lasts from three to seven days.
The follicular phase: Follicle
stimulating hormone (FSH) stimulates
several follicles (tiny sacs in the ovaries
each containing an undeveloped egg) to
start developing. One of these follicles
forms a mature egg. The ovaries also
produce the hormone oestrogen, which
causes the lining of the uterus to thicken
in preparation for possible pregnancy.
Ovulation: Occurs when the egg is
released from the follicle. It is triggered
by the rapid release of luteinising
hormone (LH) from the pituitary gland.
Self Care is a program of the Pharmaceutical Society of Australia.
Self Care is committed to providing current and reliable health information.
Related Fact Cards
Pregnancy and ovulation
Contraception
Period problems
12
A woman’s menstrual cycle begins on the
first day of menstrual bleeding (the ‘period’)
and ends on the day before her next period
begins. Although the ‘average’ length of the
menstrual cycle is 28 days, most women
have cycles between 25 and 30 days in
length. For some women the length of their
cycle varies each month, while others have
a more regular cycle. The menstrual cycle
is controlled by hormones and has four
main phases:
Menstruation
During this phase, the thickened lining of
the womb or uterus comes away from the
uterus wall and the blood and tissues pass
out through the vagina. The average
length of a menstrual period is 4–6 days,
but periods can be as short as two days
and as long as eight days.
Follicular phase
This phase starts on the first day of
menstruation (i.e. it overlaps with the
menstruation phase) and ends with
inPHARMation November 2012 I © Pharmaceutical Society of Australia Ltd.
ovulation. The pituitary gland starts
producing follicle stimulating hormone
(FSH) and luteinising hormone (LH). The FSH
stimulates several follicles (tiny sacs each
containing an undeveloped egg) within the
ovaries to start growing and developing.
The developing follicles produce oestrogen,
which stimulates the lining of the uterus to
start thickening in preparation for possible
pregnancy. At day 5–7 of the cycle, all
except one of the developing follicles start
to wither and die. The remaining follicle
continues developing and eventually
becomes a mature egg.
Ovulation
At around day 12 of the cycle, there is
a surge in the production of LH by the
pituitary gland. This triggers ovulation –
the release of the mature egg from the
follicle – 24 to 36 hours after the start of the
LH surge. The released egg begins to travel
down the fallopian tube to the uterus.
Luteal phase
After releasing its egg, the remnant of the
follicle (called the corpus luteum) starts
Getting pregnant Pharmacy assistant’s education Module 232
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Urine tests
Tests can usually detect the amount of hCG
present by the first day of a missed period.
More ‘sensitive’ tests, which are able to
detect lower levels of hCG (e.g. Clearblue,
Confirm, First Response), claim to give
accurate results if used as early as 4–5 days
before the period is due. However, testing
this early may give a false-negative result.
If the directions are carefully followed,
home pregnancy tests are 97–99% accurate.
If a home pregnancy test gives a positive
result, the woman should visit her doctor for
a pregnancy health check.
producing large amounts of progesterone
and smaller amounts of oestrogen.
These hormones maintain the thickened
lining of the uterus. If an egg is fertilised
and becomes implanted in the lining of
the uterus, it starts producing a hormone
called human chorionic gonadotrophin
(hCG), which stimulates the corpus luteum
to continue producing progesterone and
oestrogen. If an egg is not fertilised,
the corpus luteum withers and dies and the
lining of the uterus falls away. Menstruation
starts and the cycle begins again.
Becoming pregnant
An egg can live for about 24 hours after
ovulation, and sperm can survive for up to
five days in the uterus and fallopian tubes.
To provide the best chance for fertilisation
of the egg to take place a woman needs to
have sexual intercourse during the fertile
phase of her menstrual cycle – the five days
before ovulation and the day of ovulation.
There are various strategies women can use
to help them determine their fertile phase:
Look out for signs of fertility
These include:
• increased vaginal discharge that becomes
wet, clear and slippery (like raw egg white)
• softening and swelling of the external
genitals (vulva)
• increased libido (sexual desire)
• slight feeling of discomfort on one side
of the abdomen.
Keep a temperature chart
A woman’s basal body temperature
(the temperature immediately after
awakening in the morning) usually rises
by 0.2–0.5°C just after ovulation. A woman
can become familiar with her pattern of
ovulation by taking her temperature first
thing every morning and plotting the results
on a graph. Because the rise in temperature
occurs after ovulation detection of
increased basal body temperature cannot
be used to predict ovulation in that cycle.
However, it can be useful for helping her
plan when to time intercourse in the future.
These tests measure the level of LH in the
urine. In order to detect the surge in LH
that occurs 24–36 hours before ovulation,
a woman should test her urine with a
disposable test stick daily for several days
around the estimated time of ovulation.
Because a woman needs to know her
approximate time of ovulation in order
to carry out the test, she should chart at
least two menstrual cycles before using an
ovulation kit. There are different brands of
urine tests available. As these vary in relation
to the number of tests contained in each
kit and the steps necessary to complete the
test, it is important to carefully follow the
instructions that come with the kit.
The results of urine tests may not be
reliable if:
• The urine sample is too concentrated
or too dilute. The sample should be
collected at the same time each day and
the woman should avoid drinking fluids
for about two hours, and avoid urinating
for about four hours, before testing.
• Testing is started too late in the cycle and
the LH surge is missed.
• The woman has a medical condition that
can affect the results the test (e.g. thyroid
disease, polycystic ovary syndrome).
• The woman is taking a medication that
can affect the results of the test
(e.g. fertility drugs, some antibiotics).
Saliva tests
These tests are based on detecting the
rise in oestrogen levels that occurs in the
days leading up to ovulation. As oestrogen
levels rise, the salt content of the saliva
increases. If a sample of this saliva is placed
on a glass slide and allowed to dry, the salt
crystallises into a fern-like pattern that can
be seen under a microscope. These patterns
can usually be seen about 2–4 days before
ovulation. Saliva test kits contain a small
microscope, glass slides and an instruction
leaflet. Any medical condition or medication
that causes an increase in oestrogen levels
(e.g. polycystic ovary syndrome or fertility
drugs) can cause a false-positive result.
Use an ovulation predictor kit
Pregnancy tests
An ovulation predictor kit can help a woman
determine the fertile days of her cycle.
There are two main types of ovulation kits
– urine-based and saliva-based.
During the first few weeks of pregnancy the
level of hCG in a woman’s body increases
rapidly. Home pregnancy tests check for the
presence of hCG in the urine.
False-positive results
Sometimes a woman may not be pregnant
but the test gives a positive result. This may
be because:
• The woman is taking certain medicines
that can cause false-positive results.
• The woman has had a recent miscarriage
– traces of hCG can be found in the urine
for up to eight weeks after a miscarriage.
• The woman has blood or protein in
her urine.
False-negative results
Sometimes a woman may be pregnant but
the test gives a negative result. Causes of
false-negative results include:
• The test being done too early in the
pregnancy when hCG levels are too low
to be detected. A negative result can be
checked with a second test, done a few
days later.
• The test being used incorrectly.
• The sample of urine used not being
concentrated enough. The first urine
passed in the morning is the most
concentrated and is likely to give the
most accurate result. However, if the
pregnancy is well advanced (e.g. ≥1 week
after a missed period) a sample of urine
taken at any time of day should give an
accurate result. Drinking a lot of fluid
before doing the test can also dilute the
urine and cause a false-negative result.
• Certain medicines that the woman may
be taking.
Preparing for pregnancy
A woman planning to have a baby can
improve her chances of getting pregnant
and having a healthy baby by starting to
prepare for pregnancy several months in
advance. She may need to consider making
certain lifestyle improvements.
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Diet and nutrition
Having a healthy diet can improve a
woman’s chances of becoming pregnant,
as well as providing adequate stores of
essential vitamins, minerals and nutrients
for her developing baby to draw on. A diet
based on vegetables, fruit, legumes
(e.g. beans, chick peas, lentils), whole grains,
lean meat, poultry, fish and dairy foods will
help to ensure that a woman has adequate
levels of these important nutrients.
Essential vitamins and minerals
Vitamins and minerals that are particularly
important for women planning to become
pregnant include:
Folic acid – Folic acid helps to protect the
unborn baby against the risk of spina bifida
and other neural tube birth defects.
A woman should take a folic acid
supplement of 400–500 micrograms (mcg)
daily for at least 1 month before becoming
pregnant and for the first three months of
pregnancy. (If she is taking a multivitamin
supplement that already contains 400 mcg
or more of folic acid she need not take a
separate folic acid supplement). If a woman
has an increased risk of having a baby with
neural tube defects (e.g. she has diabetes
or a family history of neural tube defects,
or is taking medicine for epilepsy) she
should take 5 mg of folic acid daily.
Women planning to become pregnant
should also eat plenty of foods rich in folate
(the naturally-occurring form of folic acid).
These include green leafy vegetables
(e.g. broccoli, spinach, salad greens),
chick peas, nuts, dried beans and peas,
citrus fruits, brown rice, fortified bread and
some fortified breakfast cereals.
Iodine – Iodine is used by the body for
making thyroid hormones, which are
important for the development of the
baby’s brain and nervous system. If a
woman has iodine deficiency during
pregnancy her baby may have hearing
problems and learning difficulties as it
grows older. The best dietary sources of
iodine are seafood and iodine-fortified
breads. However, because iodine
requirements increase during pregnancy,
women planning to become pregnant
should take a daily supplement containing
at least 150 mcg of iodine both before and
during their pregnancy.
Iron – It is important for a woman to
have an adequate iron intake before and
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Getting pregnant Pharmacy assistant’s education Module 232
during pregnancy. Good sources of iron
include lean beef and lamb, chicken, fish,
eggs, green vegetables (e.g. broccoli,
cabbage, spinach), legumes, dried fruits
and iron‑enriched breakfast cereals. If a
woman planning to become pregnant is at
risk of iron deficiency (e.g. a vegetarian) she
should check with her doctor about having
her levels tested to determine whether she
requires a supplement.
Vitamin D – If a woman has low levels of
vitamin D she may have difficulty falling
pregnant, and may also have problems
during pregnancy. Although vitamin D
is found in some foods, the major source
is sunlight. If a woman is at risk of being
deficient in vitamin D (e.g. dark-skinned,
inadequate sun exposure) she should check
with her doctor, who may recommend that
she have her vitamin D levels checked and,
if necessary, take a vitamin D supplement.
Multivitamin supplements
Women wishing to take a multivitamin
supplement before or during pregnancy
should ensure it is safe to take.
Some vitamins (e.g. vitamin A) can be
harmful to the developing baby if taken
in high doses during pregnancy. There are
many different multivitamin and mineral
supplements formulated for women who
are pregnant or planning to become
pregnant. Of these, only one (Elevit with
Iodine) is a scheduled Pharmacy only
medicine. The tablets contain a higher
dose of folic acid (800 mcg) than other
multivitamin supplements, as well as 250
mcg of iodine and 60 mg of iron. As with
any medicine, a woman requesting a
multivitamin supplement for use before or
during pregnancy should be referred to the
pharmacist.
• Eat 1 serving per week of catfish or
orange roughy (deep sea perch), and no
other fish that week, or
• Eat 1 serving per fortnight of shark (flake),
swordfish or marlin, and no other fish that
fortnight.
Foods contaminated with listeria
Listeria are a type of bacteria that can cause
an infection called listeriosis. If listeriosis is
transmitted to an unborn baby it can lead to
miscarriage, premature labour, or stillbirth.
Foods that may be contaminated with
listeria should be avoided by women before
and during pregnancy (see Box 2).
Box 1. Fish that have low mercury levels
Mackerel
Silver warehou
Atlantic salmon
Tinned salmon and tuna
Herrings and sardines
Prawns, lobsters and bugs
Squid and octopus
Snapper
Trout
Trevally
Whiting
Bream
Mullet.
Box 2. Foods that may be contaminated with
listeria
• Soft and semi-soft cheeses such as brie,
camembert, ricotta, fetta, blue (unless cooked
thoroughly and eaten while hot)
• Soft-serve ice-cream, and drinks made with it
(e.g. thickshakes)
• Cold chicken, processed meats and seafood
(e.g. oysters, prawns, sashimi, smoked salmon)
• Pâté
• Pre-packaged or pre-prepared fruit and
vegetables (including buffets)
• Unpasteurised dairy products (e.g. raw goat’s milk).
Foods to avoid
Other lifestyle factors
Fish
Other lifestyle factors to be considered
by women planning to become pregnant
include:
Fish is an important part of a healthy
diet, both before and during pregnancy.
However, some fish contain high levels
of mercury, which can affect the unborn
baby’s nervous system. Women who are
planning a pregnancy or who are pregnant
should limit their intake of fish that may
have high mercury levels. The following
recommendations can be used as a guide
(1 serving = 150 g):
• Eat 2–3 servings per week of any fish and
seafood listed in Box 1, or
inPHARMation November 2012 I © Pharmaceutical Society of Australia Ltd.
• Exercise – women planning a pregnancy
should try to do 30 minutes of
moderate‑intensity activity on most days
of the week, and should also perform
regular pelvic floor exercises. Women
should tell their exercise instructor if they
are pregnant or could be pregnant, as
some exercises may not be suitable or
may need to be modified.
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Getting pregnant Pharmacy assistant’s education Module 232
• Weight – being over- or underweight can
reduce a woman’s likelihood of becoming
pregnant. Maintaining a healthy weight
can improve a woman’s chances of
becoming pregnant, and reduce the risk
of complications during pregnancy.
• Smoking – women who smoke should
aim to quit several months before
becoming pregnant. Smoking can
interfere with fertility, as well as being
harmful to the developing baby.
• Alcohol – can cause damage to the
developing baby. For women who are
pregnant or planning a pregnancy,
not drinking alcohol is the safest option.
• Caffeine – high caffeine intake can
affect fertility and increase the risk
of miscarriage. Women planning a
pregnancy should limit their daily caffeine
intake to two cups of coffee or four cups
of tea or cola drink.
• Illicit drugs – the use of illicit drugs
such as marijuana should be avoided
both before and during pregnancy. If
necessary, women can seek help from
a drug and alcohol information or
counselling service.
Communicating with
customers
pregnant, or planning to become pregnant,
before supplying a Pharmacy only medicine.
They should also consider how to ask
this question appropriately – it can be
embarrassing asking a woman who looks
pregnant whether she is pregnant if it turns
out that she isn’t! Unless it’s very clear that
the woman is pregnant, it’s probably safer to
ask ‘Are you planning to become pregnant
within the next few months?’ If the answer
to this question is ‘yes’ or ‘I’m pregnant now’
the customer should be referred to the
pharmacist.
Pharmacy assistants need to be aware
of the importance of asking women
of reproductive age whether they are
Assessment questions for the pharmacy assistant
Select one correct answer from each
of the following questions.
Answers due 31 December 2012.
Before undertaking this assessment, you
need to have read the Counter Connection
article and the associated Fact Cards.
Photocopy and/or use the answer sheet
provided. Make sure to include your
ID number.
1. During a woman’s menstrual cycle,
ovulation is triggered by a surge in
the level of which hormone?
a. b. c. d. Follicle stimulating hormone.
Luteinising hormone.
Human chorionic gonadotrophin.
Oestrogen.
2. After ovulation, for approximately
how long is a woman’s egg alive and
able to be fertilised?
a. b. c. d. 12 hours.
24 hours.
3 days.
5 days.
The pass mark for each module is five
correct answers. Participants receive one
credit for each successfully completed
module. On completion of 10 correct
modules participants receive an
Achievement Certificate.
Submit answers online
3. Which of the following counselling
points about home pregnancy tests is
CORRECT?
5. How much deep sea perch can a
woman who is planning to become
pregnant safely include in her diet?
a. Home pregnancy tests check
for the presence of luteinising
hormone in the urine.
b. If a woman is pregnant, a
pregnancy test will always give a
positive result by the first day of a
missed period.
c. A woman should be advised
to drink plenty of water before
doing a pregnancy test, to ensure
that the urine sample is not too
concentrated.
d. The sample of urine used for a
pregnancy test done a week after
a missed period can be taken at
any time of the day.
4. Which of the following supplements
should be taken by all women who
are planning a pregnancy?
a. b. c. d. e. Iodine.
Folic acid.
Vitamin D.
a and b.
a, b and c.
To submit your response to these
questions online, go to the PSA website:
www.psa.org.au/selfcare
a. b. c. d. None.
One serving per fortnight.
One serving per week.
Up to three servings per week.
6. Which of the following counselling
points about lifestyle factors for
women planning to become pregnant
is CORRECT?
a. The safest option for women
planning to become pregnant is
not to drink any alcohol at all.
b. Women who smoke should
try to cut down the number of
cigarettes they smoke each day
to 10 or less before becoming
pregnant.
c. Women planning a pregnancy
should limit themselves to five
cups of coffee per day.
d. Being underweight can improve
a woman’s chances of becoming
pregnant.
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