Background: Community pharmacist-led interventions are effective in improving health outcomes; however, their impact in improving preconception and pregnancy health is not clear. This study evaluated the effectiveness of community pharmacist-led interventions which aimed to improve health outcomes of preconception and pregnant women. Methods: A systematic review of the literature, consistent with PRISMA guidelines, was performed. Five electronic databases were searched up to February 2021. Results: Four studies, three in pregnant women and one in preconception women, were identified. The studies focused on improving micronutrient status and smoking cessation. The studies increased knowledge about, and use of, iron supplements, and improved iron status and smoking cessation rates in pregnant women, while improving knowledge regarding, and increasing the use of, preconception folic acid. The studies were ranked as weak to moderate quality. Conclusion: This review provides preliminary evidence for the potential benefit of community pharmacist-led interventions to improve the health of women before and during pregnancy.

Background Neutrophil–lymphocyte ratio (NLR) is an accessible inflammatory biomarker. Recently, baseline NLR has been shown to be independently associated with incident cardiovascular (CV) events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. The aim of the present study was to investigate the prognostic value of NLR in patients with AM. Methods All consecutive patients with a diagnosis of AM admitted to three tertiary referral cardiac centres in two countries between October 2006 and June 2020 were included in the study. Diagnosis was confirmed by either cardiac magnetic resonance or endomyocardial biopsy. The outcome measure was all-cause mortality. Patients were divided into two groups according to NLR value defined in previous studies (i.e., 2.5). Results A total of 287 patients with AM were included in the study. Baseline characteristics were comparable in both groups. Approximately two thirds of patients were males (n=194, 68%) with a mean age of 39±16 years. The main clinical presentation was predominantly infarct-like (n=215, 75%), followed by heart failure (HF) (n=46, 16%) and arrhythmic (n=26, 9%). Patients admitted with a HF presentation were more prevalent in the group with elevated NLR, while no difference was found in the other clinical presentations. For all patients, ECG features were comparable between groups. However, patients with elevated NLR presented with slightly higher LVEF (55±11% vs 50±13% respectively, p=0.003). Over a median follow-up of 54 months, higher NLR was associated with worse prognosis (Figure 1, p=0.02). Patients with high NLR have a 7-fold higher risk of adverse events during follow-up (Hazard Ratio 7.83, 95% confidence interval 1.02–59.89, p=0.047). Conclusions NLR is a promising and accessible inflammatory biomarker. In patients with AM, elevated NLR is associated with worse prognosis. Further research is advocated to confirm these data in larger populations. Funding Acknowledgement Type of funding sources: None.