05.2025 Part 1: WHO 2024 Maternal Health Recommendations: What Every Pharmacist Should Know

In this episode of the First Fill, we spotlight the World Health Organization’s 2024 maternal and perinatal health recommendations. You'll hear how pharmacists can take an active role in antenatal care by supporting patients through counselling on supplement use, safe symptom relief, and preventive health strategies.

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Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.

Episode Transcript

(00:05):
Welcome to the first Fill!
I'm Yara Al-Share.
Executive fellow in education at APhA.
I'm really excited about today's episodebecause we're talking about all things
women's health,
with a focus on how pharmacists can makea measurable impact on maternal outcomes.
We will be diving into the 2024World Health Organization, or WHO’s
recommendation on maternal healthfrom physical activity and supplement

(00:26):
counseling to symptom managementand preeclampsia prevention.
We will explore how pharmacistscan support safe pregnancies
through education, supplement counseling,and accessible symptom relief strategies.
Before we divein, I'd like to introduce my guests today
Katie Meyer and Amanda Murray.
Katie and Amanda,why don't you introduce yourselves?
Yeah, sure.
Thanks. Hi, everyone.
Katie Meyer seniordirector of content here at APhA.

(00:48):
I'm super excited to dive into this topicwith you!
Hello everyone.
I'm Amanda Murray.
I am on an elective association management
rotationwith APhA currently finishing up a year.
I won community based
pharmacy residency at Riverside Healthin Newport News, Virginia.
Welcome both. Thank you for being here.
Let's dive in.
Katie,let's start with physical activities.

(01:10):
How can pharmacists
effectively promote physical activityas part of the antenatal care?
And what counseling tipscan we use to ensure safety and adherence
during pregnancy?Yeah. Yeah. Sure. Absolutely.
So the 2024 issue guidelines recommendabout 150 minutes
of moderate physical activityper week for most pregnant people.
That might sound like a lot, but it can beas simple as a brisk walk most days.

(01:32):
The focus should be on low impact options,so think walking, swimming,
or prenatal yoga.
These activities are generally safe,
gentle on the jointsand can help with circulation and sleep.
We also need to address that myththat rest or bed rest
is always better, unless specificallyadvised due to complications.
Movement is actually beneficialand it can help
reduce back pain, improve mood,and even help with labor outcomes.

(01:56):
And of course, if someone is high riskor has pregnancy complications,
it's best to check with their obgynfirst before starting anything new.
But for most,the little movement goes a long way.
Thank you Katie and Amanda from the 2024Who recommendations.
Can you share some insights on ways
pharmacists can counsel pregnantpatients on iron, folic acid
and supplement timing, especially whenusing other medications like antacids?

(02:19):
Sure. Yara!
According to the World HealthOrganization, gestational
anemia prevalence of 20% or higher
in a population is considereda moderate public health problem.
In these settings, where supplementationis strongly recommended
to prevent complications,the World Health Organization recommends
daily oral supplementationwith iron and folic acid

(02:41):
at a dose of 30mgto 60mg of elemental iron
and 0.4mg of folic acid to reduce risk
of maternal anemia, low birthweight, and premature birth.
In populations where anemia isless common, which is a prevalence
below 20%, and daily supplementationis not feasible due to side effects.

(03:02):
Once weekly supplementation with oral
iron and folic acid is recommendedin this regimen.
However, the dosageincreased to 120mg of elemental iron
and 2.8mg of folic acid once weekly.
To compensate for the reduced frequencyand ensure
the patient still receivedadequate supplementation over time.

(03:23):
Gastrointestinal side effects like nausea,constipation,
or diarrhea are commonwith iron supplements in these cases.
Formulation.
And like ferrous bisglycinate,also known as slow iron, or ferrous
gluconate may be better toleratedand could be recommended
if patient experiencegastrointestinal upset.

(03:43):
Iron can be taken with food,but they should avoid foods that impair
absorption, such as dairy,tea, coffee, soy, and spinach.
Thank you Amanda,
and can you also sharesome non-pharmacological
or over-the-counter optionsare recommended for common pregnancy
symptomslike nausea, heartburn, and leg cramps
in pregnancy?
It's best to start with nonpharmacologic options like ginger,

(04:07):
camomile, vitamin B6,also known as pyridoxine supplements
and even acupuncture,has also been recommended
if non pharmacologic optionsare not fully helping.
Medications like doxylamineand metoclopramide can be considered,
but those would be reserved for patientswith an derm not relieved
by non pharmacologic or OTC options.

(04:29):
Ondansetron can be used for severe caseson an individualized basis,
but is preserved only when otherpharmacologic agents aren't effective due
to conflicting evidence on possible birthdefects with use in the first trimester.
Good news is that nausea
typically improves or resolvesin the second half of pregnancy,
so sometimes a little extra supportearly on is enough for heartburn.

(04:53):
Food choices really matter.
Limiting consumption of fatty foodssuch as pizza or French fries,
and acidic foods like orange juicemay help.
Other non pharmacologic options includeraising the head of the bed at night.
If non pharmacologic optionsare not enough, over-the-counter and acids
like magnesium carbonate and aluminumhydroxide are appropriate

(05:14):
for heartburn during pregnancy.
However, to return to an earlier pointabout timing between medications
and supplements, it's importantto counsel patients that antacids
can impair the absorption of those commonsupplements typically taken in pregnancy,
including iron and folic acid,and to separate them by over two hours.
Finally, for leg cramps,although there is limited evidence

(05:37):
magnesium and calciumsupplementation can be considered.
On the other hand, there is no evidencethat therapies like muscle stretching,
heat therapy, dorsiflexion of the footand massage show benefit.
Thank you Amanda!
Katie.
Let's shiftgears to hypertensive disorders,
where the strongestWho recommendations in this area
and how can pharmacists contributeto prevention and emergency care?

(05:59):
Yeah, sure!
So hypertensive disordersof pregnancy constitute
one of the leading causes of maternaland perinatal mortality worldwide.
Pre-eclampsia is a complicationof pregnancy marked by high
blood pressure and protein and ureathat may indicate
kidney damage or proteinuria, and mayalso involve damage to other organs.
If untreated,
it can progress to eclampsia,which involves life threatening seizures.

(06:22):
Pre-eclampsia usually beginsafter 20 weeks of pregnancy,
and individualswho previously had normal blood pressure.
Patients at high risk for pre-eclampsiainclude those with a history
of pre-eclampsia, chronic hypertension,type 1 or 2 diabetes, kidney disease,
autoimmune disorders as an example, lupus,and multiple gestation.
As pharmacists,

(06:43):
we can help identify these risk factorsduring routine medication reviews.
Vaccine counseling,or supplemental consultations,
especially if we see a patientearly in pregnancy or even preconception.
For high risk patients, the 2024Who recommendations strongly support
low dose aspirinsomewhere between 75 to 150mg

(07:03):
daily, and the key is to start at before20 weeks.
Pharmacists can play a big role by makingsure at risk patients are identified
early and understandwhy timing and adherence really matter.
On the flip side, the 2024Who recommendations advise against some
common non-pharmacological interventionsthat used to be widely accepted.
First, bed rest

(07:23):
and home rest are no longer recommendedfor the prevention of pre-eclampsia.
Even in patients who are consideredhigh risk, pharmacists can help
correct this misconceptionthat bedrest is always protective.
In fact, strict bedrestmay do more harm than good.
Increasing the risk of bloodclots or muscle loss.
Now, that doesn't mean no rush at all,
as the recommendations make it clearthat individual circumstances vary.

(07:47):
Another one is to flagis salt Restriction 2024.
Who recommendations do not recommendcutting or reducing
salt in pregnancy for the purposeof preventing pre-eclampsia.
There's moderate quality evidence showingit doesn't help and could even limit
essential nutrients.
Instead, we can guide patientstoward balanced eating and discourage
extreme diet changesunless advised by their provider.

(08:08):
Finally, if pre-eclampsia becomes severeand the patient has a minute
to the hospital, the treatment of choiceto prevent seizures is magnesium sulfate.
There are two main regimens.
One involves a 4 grams IV loadfollowed by 10
grams IM, then 5 grams IM every 4 hours.
The other recommendation uses the 4 gramIV load, followed by continuous

(08:30):
infusion of 1 to 2 gramsper hour via control infusion pump.
Per the WHO recommendations,magnesium sulfate is considered
the gold standardfor preventing progression to eclampsia
and should only be used in settings wherethe patient can be closely monitored.
Thank you Katie and Amanda for sharingsuch practical and insightful ways
pharmacists can support maternal healththrough evidence based care.

(08:51):
In our next episode,we will explore the pharmacists role
in the early identificationof high risk pregnancies
and how pharmacists can support earlyscreening and referrals.
We will also dive into strategiesfor improving patient communication
and health literacy, and highlight
examples of successful pharmacist-provider collaboration in maternal care.
To summarize major takeawaysfrom our time here today:
Pharmacists are key playersin delivering antenatal care

(09:13):
advice, especially regarding supplementsand symptom relief.
Aligning practice with the 2024WHO recommendations in maternal health can
advance pharmacists’ role in public healthand finally, counseling on timing, OTC
safety, and patient adherence can makea measurable impact on pregnancy outcomes.
Alright, folks,that's all the time we have for today.
Look out for part
two of this month's First Fill Podcastthat will be released next Thursday.

(09:35):
And lastbut not least, don't forget to head over
to the Learning Libraryto earn your CE for this month's podcast.
We'd love to hear your feedbackon how you like the new set up.
Goodbye and take care.