| Summary: | The prenatal use of medicines and recreational substances is of significant importance because there is insufficient information on the effects of medicines and recreational substances on pregnancy outcomes. In addition, literatures on health beliefs of pregnant women about medicine and recreational substance use are lacking. The aim of this thesis was to investigate medicine and recreational substance use during pregnancy in an antenatal population of London. The study was approved by the ethics committee. The first part of the thesis was a prospective cohort study of medicine and substance use across all trimesters (using survey methods), and the pregnancy outcomes (using the medical records); the second part was a qualitative study of the health beliefs of pregnant women which employed semi-structured telephone interviews and the Health Belief Model as a framework for data collection and analysis. The results of the prospective study demonstrated that the prevalence of use of prescription, over-the-counter and complementary and alternative medicines during at least one trimester were 32.5%, 50.2% and 57.1% respectively. The prevalence of exposure to alcohol, cigarette and illicit substances were 16.0%, 3.5% and 0.9% respectively. However, due to limited sample size, the study could not demonstrate an association between the medicines and substances used and increased risk of congenital anomalies in the baby. The qualitative study indicated that pregnant women’s adherence to medicines could be explained by women’s perception of the severity of a medical condition, risks of non-adherence to the medicine as well as anxiety about the risks of the medicine on the foetus. In the case of substance use, a low risk perception could be used to explain women’s behaviour. Healthcare professionals have a responsibility to counsel pregnant women about the benefits or risks of medicines and substances, informed by the best evidence, and guided by the women’s perceptions.
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