Preferences of pregnant women and physicians for 2 strategies for prevention of early-onset group B streptococcal sepsis in neonates

M. Peralta-Carcelen, C. A. Fargason Jr, D. Coston and J. G. Dolan
Department of Pediatrics, University of Alabama at Birmingham, USA.

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.