Alcohol and nicotine use during pregnancy: its nature, occurrence and consequences.
Duncan, Eilidh Mairi
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This PhD project investigated the nature, occurrence , and consequences of alcohol and nicotine use during pregnancy. The main objective bieng to identify those at risk of continued alcohol and nicotine use, to determine the current practice of midwives in Grampian and to identify the consequences in terms of infants' and mothers' health. Study 1 aimed to provide an estimate of the prevalence of pregnant women drinking alcohol and smoking in Grampian, and to determine the best predictors of the behaviours. One hundred and thirty pregnant women took part in study 1. Thirty-five per cent of participants reported drinking during pregnancy. Parity, health locus of control and theory of planned behaviour variables distinguished between pregnant drinkers and abstainers. Seventy-four per cent of participants were non-smokers prior to becoming pregnant. Of the smokers, 47% continued to smoke during and 53% quit. Continued smokers differed from smokers who stopped for health locus of control and theory of planned behaviour constructs. Study 2 involved a questionnaire survey of midwives' knowledge, attitudes and practice regarding alcohol and nicotine use during pregnancy. Almost 30% of community midwives in this sample (n=17/52) reported not routinely asking their patients about their alcohol use and none reported using a screening questionnaire. Over 65% felt they still required training in supporting smoking cessationand over 86% still felt they required training in supporting pregnant patients to change drinking habits. The main barriers to providing advice were a lack of training and a lack of time. Midwives who drank more alcohol per week had more permissive attitudes towards alcohol use during pregnancy that were more permissive than the current government guidelines. Finally, study 3 aimed to take forward the results of study 1 and examine the potential consequences of alcohol use on newborn infants and new mothers. No significant differences were found for infants exposed to low-level alcohol use for a number of health outcomes. First-time mothers who drank during pregnancy reported spending a longer time in hospital after labour and, within all mothers who drank during pregnancy, lower attachment scores were reported at 3 months after birth, despite no significant differences in terms of health outcomes and mental well being. However, these findings are exploratory and factors other than drinking during pregnancy may be influential. The three studies together provide an insight into the incidence and determinants of alcohol and nicotine use during pregnancy and shed light on midwives' practice and barriers to providing advice to pregnant patients. The results yield strategies for intervention work and recommendations for practice and further research.