Preconception Counseling: Beyond a Pharmacist’s Role or an Important Niche for Your Pharmacy?
Thirty-six-year-old Janice sat in the examination room, waiting to get her regular Pap smear. After knocking on the door, the gynecologist entered and greeted her with, “So, what are your plans regarding pregnancy?” Since pregnancy was the last thing on Janice’s mind—and the question was uncharacteristically blunt for the doctor’s usual laid-back manner—Janice was speechless. The doctor explained that she decided to get aggressive with preconception counseling following a surge in high-risk patients with unplanned pregnancies. Of course, this approach fits her role as a gynecologist, but what about pharmacists? Should you become involved in preconception counseling and if so, what’s the appropriate approach to take?
Benefits of Preconception Counseling and the Potential Market
Pharmacists are increasingly encouraged to take a broader role in patient care. A recent article in Pharmacotherapy called for pharmacists to fill the gap in preconception care by including it as part of medication management.1 And with their expertise and visibility in the community, compounding pharmacists stand to make a significant contribution to their patients’ health. But then you have to wonder how many outreach responsibilities you can—or should—assume. So should you consider adding preconception counseling to the services you offer? To help answer that question, consider how many women are affected and whether you can make a difference.
The statistics related to preconception counseling begin with unintended pregnancies. In spite of a drop between 2008 and 2011, the numbers are still huge—45 percent of all pregnancies are unintended.2 Nearly one million American women deliver babies without getting adequate medical attention and barely 18 percent receive preconception care. Most women don’t see a doctor until they’re 12 to 14 weeks pregnant.3 By then it’s too late to prevent first-trimester birth defects. Babies born to women who don’t receive sufficient care are three times more likely to be low in birth weight and five times more likely to die.4 Considering these facts, it becomes clear that, yes, preconception counseling makes a difference.
How to Implement Preconception Outreach
The most challenging aspect of preconception outreach is figuring out how to go about it. Unlike the gynecologist and her patient, you can’t simply confront random women with questions about family planning. While this type of outreach should be subtle, compounding pharmacists have an advantage because they can target women filling prescriptions for chronic health conditions that put them at risk for pregnancy complications. Begin by reaching out to these women:
- Diabetic patients: Women with pregestational diabetes face a higher risk of miscarriages, low-birth-weight babies and preterm deliveries, especially if their blood glucose is poorly controlled before they become pregnant. Persistent hyperglycemia before and during pregnancy is associated with cardiac and renal malformations, stillbirth and neonatal death.5
- Migraine headaches: Although the rise in hormones during the 2nd and 3rd trimesters sometimes reduces the frequency of migraine headaches, more than half of women with migraines have adverse outcomes, such as preeclampsia, low birthweight and preterm deliveries. The risk increases sevenfold in women over the age of 35. 6
- High blood pressure: Women with high blood pressure or kidney disease prior to pregnancy are more likely to develop preeclampsia. Other groups at risk for preeclampsia include those with a history of gestational hypertension and women younger than 20 or older than 40.
- Overweight women: It’s estimated that one-third of women are overweight when they become pregnant. Babies born to these women have twice the risk of dying.7
You won’t risk alienating women with outreach if you use informational material. For example, hand out a generic brochure, such as “Women and Migraines: What You Need to Know Before Getting Pregnant.” Gently bring it to their attention by saying you want to be sure they’re aware of how their condition affects planning for the future. May is National Teen Pregnancy Prevention Month, which opens the door to outreach for teens and moms. You’ll find a lot of information for handouts at the Advocates for Youth website.8
Recommendations for Medications and Supplements
Ninety-six percent of pregnant women calling a medical center help line asked about the safety of taking medications before and during pregnancy. Take advantage of this concern by putting up posters about medications and pregnancy, and letting patients know you’re available to answer questions.
- Category D and X medications: Take a proactive approach toward women taking Category D, Category X or any other medications that may impact pregnancy, such as isotretinoin, orlistat, phenytoin and warfarin. The prescribing physician may not have asked these women if they planned to become pregnant and despite warnings, 6 percent of pregnancies occur in women taking medications with a known teratogenic risk.
- Over-the-counter medications: Most women who are pregnant or planning to become pregnant should avoid NSAIDs, whether OTC or by prescription. Aspirin, ibuprofen, acetaminophen, antacids, and most OTC antihistamines, decongestants and expectorants are rated as Category B or C.9
- Topical creams: Topical antifungal, antimicrobial and OTC hydrocortisone 1 percent are considered safe, but more potent topical corticosteroids may represent a risk.
- Plan for morning sickness: About 70 to 80 percent of women experience morning sickness, so preconception counseling is a good time to talk about compounded treatments should they suffer from hyperemesis gravidarum.
Preconception counseling must include a discussion about diet and nutrition, as the mother’s nutritional status before conception is nearly as important as nutrition during pregnancy. In fact, the American Pregnancy Association recommends that women begin to make necessary changes three months to a year before trying to conceive.
- Folic acid: Women may have heard about the importance of folic acid, but most don’t realize that supplements must be taken before they become pregnant to prevent neural tube defects that occur in the first few weeks—a time when most women don’t know yet that they’re pregnant.
- Other nutrients: It goes without saying that getting a sufficient amount of all essential vitamins and minerals is important, but women should pay extra attention to calcium, iron, zinc, and vitamins B6, B12, C and A. Women can begin taking OTC prenatal vitamins before conception, but this is a good time to explore whether compounded supplements are a better option.
Preconception Counseling Builds Your Business
Nearly 90 percent of women report being in good health prior to pregnancy, according to the CDC’s Pregnancy Risk Assessment Monitoring System. While that’s great news, feeling good may prevent women who need preconception care from consulting their doctor. As you tap into this market with outreach, you’ll make some immediate sales, but the impact to your bottom line carries into the future. Preconception counseling will turn one-time customers into enduring patients and you’ll gain new patients as women in the community learn to rely upon the care you provide.
Pharmaceutica North America provides the high-quality compounding kits, active pharmaceuticals and topical delivery bases pharmacists need to meet the treatment goals of women before, during and after pregnancy. Please contact us today to learn more about how we can support your compounding pharmacy.
- “Fulfilling an Unmet Need: Roles for Clinical Pharmacists in Preconception Care,” February 2016, http://www.ncbi.nlm.nih.gov/pubmed/26846305 ↩
- “Declines in Unintended Pregnancy in the United States, 2008—2011,” March 2016, http://www.nejm.org/doi/full/10.1056/NEJMsa1506575#t=article ↩
- “Prenatal Services,” 2016, http://www.raabecollegeofpharmacy.org/mtm/mod/resource/view.php?id=5 ↩
- “Delivering Preconception Medication Management Services in the Community Pharmacy,’ June 2015, http://www.raabecollegeofpharmacy.org/mtm/mod/resource/view.php?id=5 ↩
- “The Challenges and Future Considerations Regarding Pregnancy-Related Outcomes in Women with Pre-Existing Diabetes,” December 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836194/ ↩
- “Pregnant Women With Severe Migraine May Be at Increased Risk for Labor and Delivery Complications,” March 2016, http://www.prnewswire.com/news-releases/pregnant-women-with-severe-migraine-may-be-at-increased-risk-for-labor-and-delivery-complications-300230520.html ↩
- “Maternal Obesity and Gestational Weight Gain are Risk Factors for Infant Death,” February 2016, http://www.ncbi.nlm.nih.gov/pubmed/26572932 ↩
- “National Teen Pregnancy Prevention Month,” 2015, http://www.advocatesforyouth.org/topics-issues/teen-pregnancy-prevention/1304-tpp ↩
- “Over-the-Counter Medications in Pregnancy,” October 2014, http://familymed.uthscsa.edu/residency08/mmc/Pregnancy_Medications.pdf ↩