Pre-Conception Practices Among FamilyPhysicians and Obstetrician-Gynaecologists:Results from a National Survey

Abstract

ObjectiveTo determine the pre-conception practices amongobstetrician-gynaecologists and family physicians in Canada. MethodsBetween October 2001 and May 2002, a survey wasmailed to a national random sample of obstetricians andgynaecologists (n = 539) and family physicians (n = 2378) whowere current members of the College of Family Physicians ofCanada or the Society of Obstetricians and Gynaecologists ofCanada. ResultsResponse rates were 41.7% among obstetriciangynaecologistsand 31.1% among family physicians. More than85% of physicians frequently discussed birth control and Paptesting with women of childbearing age, but fewer than 60%frequently obtained a detailed history of alcohol use. Fewer than50% of physicians frequently discussed the following with womenof childbearing age: weight management, workplace stress, mentalhealth, addiction history, or the risks of substance use duringpregnancy. Fewer than 15% enquired about a history of sexual oremotional abuse. Family physicians were significantly more likelythan obstetrician-gynaecologists to discuss mental health (41.1%vs. 28.1%), depression (44.5% vs. 29.0%), and history of alcoholuse (59.8% vs. 47.9%) with women of childbearing age (all P <0.05). Obstetrician-gynaecologists were significantly more likelythan family physicians to discuss folic acid (57.8% vs. 47.2%),sexual abuse (18.2% vs. 10.8%), smoking (56.0% vs. 46.1%), anddrug use (45.8% vs. 35.9%) (all P < 0.05) with women ofchildbearing age who were not pregnant. ConclusionThere are missed opportunities in pre-conceptionscreening to identify women with suboptimal reproductive healthstatus who are at risk for adverse conception, pregnancy, and birthoutcomes. Physician training in identification of women at riskwould allow for increased primary and secondary prevention effortsthrough referral to appropriate treatment and resources.