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.