Effects of modifiable lifestyle choices and related public health policy in pregnancy. Impact on maternal and offspring outcomes, a population-based linkage study

Kinsella, Michael (2025) Effects of modifiable lifestyle choices and related public health policy in pregnancy. Impact on maternal and offspring outcomes, a population-based linkage study. MD thesis, University of Glasgow.

Abstract

Alcohol and opioid use during pregnancy are associated with adverse maternal and perinatal outcomes. This thesis examines the impact of public health interventions on alcohol consumption during pregnancy and on perinatal outcomes. Associations between different levels of alcohol consumption and maternal and childhood outcomes are also explored. Finally, the impact of different opioid substitution therapies, Methadone and Buprenorphine, on perinatal outcomes is systematically assessed.

Population-based data from Scotland is used to conduct an interrupted time series analysis of the impact of three public health interventions on alcohol consumption during pregnancy and perinatal outcomes (Chapter 2). To explore different levels of alcohol consumption during pregnancy on perinatal outcomes, women who consumed less than or equal to four units of alcohol per week were compared to women who consumed no alcohol, and women who consumed greater than four units of alcohol per week. Multivariable regression models were used to assess the associations between alcohol consumption and perinatal outcomes (Chapter 3). Finally, a systematic review and meta-analysis was performed to compare methadone and buprenorphine therapies on pregnancy outcomes (Chapter 4 and 5).

In Scotland, approximately one in four women report drinking alcohol in pregnancy. Minimum unit pricing was associated with a reduction in volume of alcohol consumption during pregnancy, and in babies born small for gestational age, neonatal unit admissions, and stillbirths. Alcohol consumption of under four units of alcohol per week was not associated with any increase in adverse perinatal outcomes, but harm was more likely to occur as consumption increased. In a meta-analysis of opioid substitution therapies, Buprenorphine compared with Methadone was associated with improvements in neonatal and maternal outcomes in both RCTs and Cohort Studies.

Alcohol consumption during pregnancy is common, with many women consuming less than four units per week. The implementation of a universal policy to increase the cost of alcohol was associated with a fall in alcohol consumption among pregnant women and improvement in pregnancy outcomes, and this can be monitored using routinely collected data. Buprenorphine improved perinatal outcomes compared to Methadone.

This body of work uses routinely collected healthcare data to examine the impact of public health measures and treatment strategies to minimise harm from exposure to alcohol and drugs in the pregnant population. A combination of narrative review, systematic review and meta-analysis, time-series analysis, and regression modelling was used to achieve this. The studies included in this thesis highlight the importance of population-based public health measures and evidence-based treatments, demonstrating that such interventions have a positive impact on the pregnant population resulting in improved maternal and childhood outcomes.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Subjects: H Social Sciences > HV Social pathology. Social and public welfare; R Medicine > RA Public aspects of medicine; R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine; R Medicine > RG Gynecology and obstetrics
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Supervisor's Name: Nelson, Professor Scott and Kearns, Professor Rachel
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85508
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 08 Oct 2025 08:44
• Last Modified: 08 Oct 2025 08:48
• Thesis DOI: 10.5525/gla.thesis.85508
• URI: https://theses.gla.ac.uk/id/eprint/85508

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