title: Counseling patients on preventing prenatal environmental exposures--a mixed-methods study of obstetricians.
abstract: OBJECTIVE
  Describe the attitudes, beliefs, and practices of U.S. obstetricians on the topic of prenatal environmental exposures.
  
  
  METHODS
  A national online survey of American Congress of Obstetricians and Gynecologists (ACOG) fellows and 3 focus groups of obstetricians.
  
  
  RESULTS
  We received 2,514 eligible survey responses, for a response rate of 14%. The majority (78%) of obstetricians agreed that they can reduce patient exposures to environmental health hazards by counseling patients; but 50% reported that they rarely take an environmental health history; less than 20% reported routinely asking about environmental exposures commonly found in pregnant women in the U.S.; and only 1 in 15 reported any training on the topic. Barriers to counseling included: a lack of knowledge of and uncertainty about the evidence; concerns that patients lack the capacity to reduce harmful exposures; and fear of causing anxiety among patients.
  
  
  CONCLUSIONS
  U.S. obstetricians in our study recognized the potential impact of the environment on reproductive health, and the role that physicians could play in prevention, but reported numerous barriers to counseling patients. Medical education and training, evidence-based guidelines, and tools for communicating risks to patients are needed to support the clinical role in preventing environmental exposures that threaten patient health.
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors: Naomi E
authors: NE
authors: Stotland
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors: Patrice
authors: P
authors: Sutton
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors: Jessica
authors: J
authors: Trowbridge
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors: Dylan S
authors: DS
authors: Atchley
authors: The American College/Congress of Obstetricians and Gynecologists, Washington, District of Columbia, United States of America; Roseville-Sacramento Kaiser Permanente, Sacramento, California, United States of America.
authors: Jeanne
authors: J
authors: Conry
authors: Pediatrics, Environmental Medicine, and Health Policy, New York University, New York, New York, United States of America.
authors: Leonardo
authors: L
authors: Trasande
authors: Division of Behavioral Sciences, Professionalism, and Ethics, School of Dentistry, University of California San Francisco, San Francisco, California, United States of America.
authors: Barbara
authors: B
authors: Gerbert
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors: Annemarie
authors: A
authors: Charlesworth
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors: Tracey J
authors: TJ
authors: Woodruff
mesh_terms: D001291:Attitude of Health Personnel; D004782:Environmental Health / Q000193:education; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009774:Obstetrics; D010353:Patient Education as Topic; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000517:prevention & control*