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Myriam Peralta-Carcelen, MD, MPH; Crayton A. Fargason, Jr, MD, MM; Denise Coston, MA; James G. Dolan, MD

Arch Pediatr Adolesc Med. 1997;151(7):712-718.

Abstract
Objectives
To assess preferences of pregnant women, pediatricians, and obstetricians for the policies of the American College of Obstetrics and Gynecology (ACOG) and American Academy of Pediatrics (AAP) for reducing the incidence of neonatal group B streptococcal (GBS) sepsis.

Design
An interactive interview using a computer-based decision-making model (analytic hierarchy process) and a self-administered survey assessing the interview process.

Setting
An obstetric clinic at a university center and offices of practicing physicians from the Birmingham, Ala, area.

Participants
Ninety-two pregnant women selected by a systematic sampling technique and 40 pediatricians and 40 obstetricians selected randomly.

Main Outcome Measure
Ranking of the ACOG and AAP policies and the 5 criteria on which the decision was based: risk of infection to an infant, knowledge of maternal GBS status, risk of anaphylaxis to mother, diagnostic tests received by healthy infants, and cost. Satisfaction with the interview process also was measured.

Results
Eighty-three women (90%), 40 pediatricians, and 40 obstetricians (100%) provided responses suitable for analysis. Sixty-seven pregnant women (81%), 26 pediatricians (65%), and 6 obstetricians (15%) preferred the AAP strategy. The ACOG policy was the preferred strategy by 34 (85%) obstetricians. The 3 groups ranked risk of infection in an infant as the most important criterion in their decisions. Ranks for the other criteria differed among the 3 groups. Women ranked knowledge of maternal GBS status more important than did pediatricians and obstetricians. Thirty obstetricians (75%), 35 pediatricians (87.5%), and 72 pregnant women (86.7%) liked the interview. Seventy-three women (88%), 29 pediatricians (72.5%), and 17 obstetricians (42.5%) thought physicians should use this type of interview to assist in managing patients.

Conclusions
Pregnant women, pediatricians, and obstetricians had different priorities when making a decision about GBS policies. These differences led obstetricians to prefer a different policy than that of pediatricians and pregnant women. Obstetricians were less likely to endorse the use of this decision-making technique in their practice than were patients and pediatricians.

Arch Pediatr Adolesc Med. 1997;151:712-718

Author Affiliations
From the Division of General Pediatrics, Department of Pediatrics, The University of Alabama at Birmingham (Drs Peralta-Carcelen and Fargason and Ms Coston); and the Department of Medicine, University of Rochester, Rochester, NY (Dr Dolan).

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