Research projects

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Adverse health, neurodevelopmental and educational outcomes in offspring following in utero exposure to maternal medication

Background: Pregnancy is a vulnerable period when the foetus undergoes rapid development; therefore, exposure to adverse risk factors can have lifelong implications. Use of medicines during pregnancy is avoided where possible but is sometimes unavoidable. Whilst acute adverse effects following foetal exposure in utero have been assessed for several medicines, possible longer-term effects, specifically offspring neurodevelopmental delay and educational outcomes, are not well understood. Scotland and Wales are both world leading in having comprehensive countrywide health and education data which can be linked at an individual level enabling novel research to answer such questions.

Hypothesis: We hypothesise that some medications taken during pregnancy will be associated with poor child health, child neurodevelopmental and child educational outcomes.

Main aim: The overall research aim is to study pregnancy and long-term adverse outcomes in the offspring associated with antenatal exposure to medication. We aim to link pregnant mothers taking medication for specific conditions to a range of datasets to investigate the impact of antenatal drug exposure on obstetric and foetal outcomes, and longer-term health outcomes in the children.

Objectives: We specifically want to investigate the association between specific medications taken during pregnancy and

1. subsequent pregnancy outcomes
2. subsequent child health outcomes
3. subsequent child neurodevelopmental outcomes
4. subsequent child educational outcomes

Methods: The Scottish maternity database (SMR02) collects data on all births occurring in Scotland and includes maternal, obstetric and child factors and outcomes. Retrospective linkage to national prescribing data (2009-2019) will provide information on all prescribed medications dispensed to women immediately prior to, and during, their pregnancy (2010-2019) including dose and duration; whilst linkage to other health and education datasets will enable us to study a wide range of outcomes. We are specifically interested in pregnant women receiving medication to treat the following conditions: epilepsy, depression, ADHD, psychosis, asthma, diabetes (Type1, Type2 and gestational), hypertension, musculoskeletal pain, migraine, indigestion/heartburn/reflux, nausea/morning sickness, opiate drug withdrawal, and any infection necessitating prescription of antibiotics. Medications of interest therefore include: antiepileptics, antidepressants, antipsychotics, psychotropic agents, antihypertensives, antiasthma, methadone and buprenorphine, NSAIDs/paracetamol, antimigraine, H2 antagonists and proton pump inhibitors, anti-emetics, oral hypoglycaemics and insulin, and antibiotics. We will compare pregnancy, foetal and child outcomes for women receiving medications for specific conditions during the antenatal period compared to those who did not. We will utilise the SAIL Databank to replicate / validate our Scotland-wide research on pregnant women living in Wales using comparable population-wide Welsh data. The Welsh data will enable us to investigate the same outcomes described below and, in addition to national prescribing data, provides the added strength of national primary care data which is not available in Scotland. These data will enable us to additionally identify mother and child conditions recorded through GP records and will enable our comparison group of women not receiving the drugs of interest to be split further into those who have the underlying condition but are not medicated and those who do not have the underlying condition at all. Analysing these groups will enable us to differentiate between associations with the underlying condition and associations with the drugs used to treat them.

Expected outcomes: Demonstration of adverse associations or failure to demonstrate adverse associations would both be informative to clinicians and pregnant women in terms of caution or reassurance regarding use of the specific drug during pregnancy.

Supervisors: 

1. Dr Michael Fleming
2. Professor Daniel Mackay
3. Professor Jill Pell

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Overview

Public Health research plays a vital role in understanding the impact of biological, social, behavioural, economic, cultural and environmental factors on our health. Our interests span medical, environmental and social sciences and offer students an opportunity to train in a unique interdisciplinary culture and environment.

The advent of large scale data sets from health services, the environment, public services and the private sector is heralding something of a revolution in approaches to public health. For the first time, we are potentially able to see both how people’s health is created, maintained or damaged over time, but also the impact of interventions and policies aimed at improving and protecting health.

PGR students in public health can access the researcher training programmes in the Colleges of Medical, Veterinary and Life Sciences (MVLS) and the College of Social Science (CoSS).  This ensures that PGR students graduate with robust, transferable skills that are relevant to future employment in academia and public, private and third sector organisations. 

Our research objectives are to:

• understand the natural course and impact of cardiovascular and other chronic diseases
• contribute to service developments to improve cancer survival
• contribute to a healthier population and environment through policy-related research
• reduce health inequalities of the working age population through cutting-edge, policy informing research

Individual research projects are tailored around the expertise of principal investigators within public health and the Institute of Health and Wellbeing. Our supervisors use a variety of approaches to understand complex problems including complex statistical analysis, data linkage, longitudinal epidemiological and advanced meta-analysis, but also in depth qualitative techniques and the analysis of new media and policy documentation. We have excellent engagement with the government, the NHS and local authorities, other statutory public organisations and third sector organisations.

Specific areas of interest include:

• the potential for different aspects of environment to positively influence population health and reduce health inequalities
• the differences between chronological and biological ageing and its influence on coronary arterial disease
• evaluating the effects of legislation on population health, such as smoke free legislation
• understanding the interaction of genetic and non-genetic risk factors on population health
• the evaluation of complex public health interventions
• the impact on health of supporting disadvantaged groups into employment

Studying for a PhD in a vibrant, interdisciplinary environment will equip you with transferable research skills that are relevant to a range of career options in the public, private and charitable sectors. Many students find employment in the University sector after completing their studies or choose to pursue careers in health services, government or NGOs with a focus on global health improvement.

Many of our project supervisors have strong academic connections with international collaborators in universities and research institutes across the world. Funds are available through the college of Medical, Veterinary and Life Sciences to allow international visits to teams and data centres where part of your project can be carried out, if you and your supervisor decide this would enhance your research and training. This provides an excellent opportunity for networking and increasing your scientific knowledge and skill set.

Study options

PhD

• Duration: 3/4 years full-time; 5 years part-time

Individual research projects are tailored around the expertise of principal investigators.

Integrated PhD programmes (5 years)

Our Integrated PhD allows you to combine masters level teaching with your chosen research direction in a 1+3+1 format. 

International students with MSc and PhD scholarships/funding do not have to apply for 2 visas or exit and re-enter the country between programmes. International and UK/EU students may apply.

Year 1

Taught masters level modules are taken alongside students on our masters programmes. Our research-led teaching supports you to fine tune your research ideas and discuss these with potential PhD supervisors. You will gain a valuable introduction to academic topics, research methods, laboratory skills and the critical evaluation of research data. Your grades must meet our requirements in order to gain entry on to a PhD research programme. If not, you will receive the masters degree only.

Years 2, 3 and 4

PhD programme with research/lab work, completing an examinable piece of independent research in year 4.

Year 5

Thesis write up.

MD (Doctor of Medicine)

• Duration: 2 years full-time; 4 years part-time (for medically-qualified graduates only)