Pre-conception practices among family physicians and obstetrician-gynaecologists: results from a national survey.
OBJECTIVE
To determine the pre-conception practices among obstetrician-gynaecologists and family physicians in Canada.


METHODS
Between October 2001 and May 2002, a survey was mailed to a national random sample of obstetricians and gynaecologists (n = 539) and family physicians (n = 2378) who were current members of the College of Family Physicians of Canada or the Society of Obstetricians and Gynaecologists of Canada.


RESULTS
Response rates were 41.7% among obstetrician-gynaecologists and 31.1% among family physicians. More than 85% of physicians frequently discussed birth control and Pap testing with women of childbearing age, but fewer than 60% frequently obtained a detailed history of alcohol use. Fewer than 50% of physicians frequently discussed the following with women of childbearing age: weight management, workplace stress, mental health, addiction history, or the risks of substance use during pregnancy. Fewer than 15% enquired about a history of sexual or emotional abuse. Family physicians were significantly more likely than obstetrician-gynaecologists to discuss mental health (41.1% vs. 28.1%), depression (44.5% vs. 29.0%), and history of alcohol use (59.8% vs. 47.9%) with women of childbearing age (all P < 0.05). Obstetrician-gynaecologists were significantly more likely than family physicians to discuss folic acid (57.8% vs. 47.2%), sexual abuse (18.2% vs. 10.8%), smoking (56.0% vs. 46.1%), and drug use (45.8% vs. 35.9%) (all P < 0.05) with women of childbearing age who were not pregnant.


CONCLUSIONS
There are missed opportunities in pre-conception screening to identify women with suboptimal reproductive health status who are at risk for adverse conception, pregnancy, and birth outcomes. Physician training in identification of women at risk would allow for increased primary and secondary prevention efforts through referral to appropriate treatment and resources.
Tough
Suzanne C
SC
Department of Paediatrics, University of Calgary, Calgary AB; Department of Community Health Sciences, University of Calgary, Calgary, AB; Decision Support Research Team, Calgary Health Region, Calgary AB.
Clarke
Margaret
M
Department of Paediatrics, University of Calgary, Calgary AB.
Hicks
Matt
M
Department of Community Health Sciences, University of Calgary, Calgary, AB; Decision Support Research Team, Calgary Health Region, Calgary AB.
Cook
Jocelynn
J
Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON.
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D003625:Data Collection; D037001:Directive Counseling; D005260:Female; D006176:Gynecology / Q000379:methods / Q000592:standards*; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000379:methods / Q000592:standards*; D010821:Physicians, Family / Q000592:standards*; D010818:Practice Patterns, Physicians'; D016742:Preconception Care / Q000379:methods* / Q000592:standards*; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors