Are pharmacists engaged? But how much interest has there been among pharmacists in taking up GSK's offer of support in medicines management, rather than just requesting information? Ms Crane says that at the moment it is difficult to say. "The diabetes initiative runs across 30 pharmacies but it is a pilot we're in wait and see mode really." However, the level of interest from pharmacists can be gauged to some extent by the number who have requested the asthma packs, which was 600 at the last count. Although GSK has paid some pharmacists in the past for taking part in specific medicines management projects, it does not see this as a way forward in future. "It's not something that we would build into our scheme. We don't have a role in terms of remuneration but do understand that many pharmacists have concerns about the time that is taken with doing medicines management, " Ms Crane points out. Nevertheless, the company says that it sees medicines management as playing an important role in increasing patient satisfaction with their medicines. "We view the whole development of medicines management schemes very positively. What is of paramount importance to us is that patients get the best value from their medicines that are prescribed and so to me the pharmacists' extended role is really key to that." Ms Crane adds that it is not just GSK, but the pharmaceutical industry in general which recognises the increasing importance of medicines management. This seems to be borne out by the interest generated in.

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How much weight gain should I recommend? In the first part of the 20th century, most medical authorities recommended weight gains of 9 kg less. By the 1970s, women were being instructed to gain at least 11 kg because it was thought that insufficient weight gain could result in low birthweight babies. Interestingly, the 1945 Dutch "hunger winter" findings, which described changes in birth weight in near starvation circumstances, only resulted in reduction in mean birth weight by 300 grams. Recently, concerns have been raised about the adverse effects of large weight gains in pregnancy for both mother and baby. Observational studies have shown a relationship between high maternal weight gain and short-term adverse outcomes, such as infant macrosomia and operative delivery. There is also evidence to suggest that large weight gains in pregnancy increase the incidence of long-term obesity and subsequent associated health risks in women. The current literature suggests a weight gain range for women with a normal body mass index ; between 6.8 kg 15 lbs ; and 11.4 kg 25 lbs ; . What if my patient is overweight? The Cochrane Collaboration assessed the literature for the effects of prescribing a low-calorie diet to pregnant women who are either overweight or who had high weight gain early in pregnancy. What did they find? An calorie protein restricted diet leads to significantly lower weekly weight gain and lower birth weight, but doesn't have a clear effect on pregnancy-induced hypertension or on pre-eclampsia. Other outcomes, such as fetal infant mortality or changes in cesarean section rates, have not been reported in the literature. The researchers suggest that protein energy restriction for these women is unlikely to be beneficial and may be harmful to the developing fetus. What kind of diet should I recommend? The Cochrane Collaboration reviewed the literature for the effects of advising pregnant women to increase their calorie or protein intake. Nutritional advice is effective in increasing pregnant women's energy and protein intakes, but the implications for fetal, infant or maternal health can't be determined from the trials done to date. A recent British prospective study of Caucasian women with singleton pregnancies reported that placental and birth weights were unrelated to intake of fat, protein or carbohydrates. Researchers suggest that pregnant women should follow a prudent diet for the general population, such as in the Canada Food Guide. Women at specific risk from undernutrition would probably benefit from multifactorial outreach programs including nutritional counselling and diligent antenatal care with particular attention paid to weight gain in the third trimester. Should I suggest taking vitamins and minerals? All women wishing to become pregnant should be counselled to ingest 0.4 to 0.8 mg of foliv acid daily at least one month before and three months after conception to prevent neural tube defects NTD ; . Women at high risk Type 1 diabetes, on valproic acid, carbamazepine or foilc acid antagonists, or a previous child or family member with NTD ; should take 4 mg of dolic acid daily during the three.

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