title: Differing attitudes toward fetal care by pediatric and maternal-fetal medicine specialists.
abstract: OBJECTIVE
  The expansion of pediatric-based fetal care raises questions regarding pediatric specialists' involvement in pregnancies when maternal conditions may affect pediatric outcomes. For several such conditions, we compared pediatric and obstetric specialists' attitudes regarding whether and when pediatrics consultation should be offered and their views about seeking court authorization to override maternal refusal of physician recommendations.
  
  
  METHODS
  We used a mail survey of 434 maternal-fetal medicine specialists (MFMs) and fetal care pediatric specialists (FCPs) (response rate: MFM, 60.9%; FCP, 54.2%).
  
  
  RESULTS
  FCPs were more likely than MFMs to indicate that pediatric counseling should occur before decisions regarding continuing or interrupting pregnancies complicated by maternal alcohol abuse (FCP versus MFM: 63% vs 36%), cocaine abuse (FCP versus MFM: 60% vs 32%), use of seizure medications (FCP versus MFM: 62% vs 33%), and diabetes (FCP versus MFM: 56% vs 27%) (all P < .001). For all conditions, MFMs were more than twice as likely as FCPs to think that no pediatric specialist consultation was ever necessary. FCPs were more likely to agree that seeking court interventions was appropriate for maternal refusal to enter a program to discontinue cocaine use (FCP versus MFM: 72% vs 33%), refusal of azidothymidine to prevent perinatal HIV transmission (80% vs 41%), and refusal of percutaneous transfusion for fetal anemia (62% vs 28%) (all P < .001).
  
  
  CONCLUSIONS
  Pediatric and obstetric specialists differ considerably regarding pediatric specialists' role in prenatal care for maternal conditions, and regarding whether to seek judicial intervention for maternal refusal of recommended treatment.
authors.affiliation: Department of Radiology, Boston Children's Hospital, Boston, MA 02115, USA. stephen.brown@childrens.harvard.edu
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Brown
authors.forename: Karen
authors.initials: K
authors.lastname: Donelan
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Martins
authors.forename: Kelly
authors.initials: K
authors.lastname: Burmeister
authors.forename: Terry L
authors.initials: TL
authors.lastname: Buchmiller
authors.forename: Sadath A
authors.initials: SA
authors.lastname: Sayeed
authors.forename: Christine
authors.initials: C
authors.lastname: Mitchell
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ecker
mesh_terms: D000025:Abortion, Eugenic / Q000331:legislation & jurisprudence / Q000523:psychology; D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003376:Counseling; D003625:Data Collection; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008297:Male; D008427:Maternal Health Services; D008511:Medicine; D008875:Middle Aged; D009359:Neonatology; D009774:Obstetrics; D010372:Pediatrics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D011295:Prenatal Care; D012017:Referral and Consultation; D016312:Treatment Refusal / Q000331:legislation & jurisprudence / Q000523:psychology; D014481:United States