OBJECTIVE: To describe obstetrician-gynecologists' practices and attitudes related to substance use screening in pregnant patients. STUDY DESIGN: A 2017 cross-sectional survey assessed US obstetrician-gynecologists' (n = 462; response rate = 34%) practices (substance use screening frequency and methods) and attitudes (practice priority of screening, confidence in treating, and responsibility statements). Chi-squared tests and adjusted modified Poisson regression were used to estimate associations between practices and attitudes. RESULTS: Of 353 respondents with screening information, 79% frequently screen for substance use and 11% used a validated instrument. Confidence was the highest for treating pregnant patients using tobacco (81%). Respondents whose practices make it a high priority to screen for all substances were 1.2 times as likely to frequently screen as their counterparts (95% CI: 1.1-1.3). CONCLUSIONS: Four out of five obstetricians-gynecologists reported a high frequency of substance use screening in pregnant patients. Findings highlight the importance of increasing priority of substance use screening by obstetrician-gynecologists.

OBJECTIVE: To describe obstetrician-gynecologists' practices and attitudes related to opioid use among pregnant and postpartum women. STUDY DESIGN: A 2017 cross-sectional survey assessed U.S. obstetrician-gynecologists' (N = 462; response rate = 34%) practices (management) and attitudes (knowledge, preparedness, confidence, barriers, and resources needed) related to opioid use among pregnant and postpartum women. Modified Poisson regression determined adjusted prevalence ratios (aPR) for advising medication-assisted therapy (MAT) for pregnant women with opioid use disorder (OUD) by knowledge, confidence, and preparedness. RESULTS: Of respondents, 33% always or usually advised MAT to pregnant women with OUD. Confidence in treating pregnant women who use opioids (aPR: 1.3, 95% CI: 1.0-1.8) and knowledge that substance use services were covered under the Affordable Care Act (aPR: 1.4, 95% CI: 1.1-1.8) were associated with advising MAT. CONCLUSION: Evidence suggests that efforts are needed to enhance physician confidence to manage pregnant and postpartum patients who use opioids, which may increase optimal care of this patient population.

PURPOSE: Trichomoniasis is the most prevalent non-viral sexually transmitted infection in the United States. It can present with vaginitis in women and urethritis in men, but is most often asymptomatic or occurs with minimal symptoms. It is associated with other sexually transmitted infections (STIs), adverse pregnancy outcomes and pelvic inflammatory disease. For these reasons, healthcare provider awareness of trichomoniasis is of public health importance. METHODS: To assess practitioner knowledge, attitudes, and practices concerning trichomoniasis management, the American College of Obstetricians and Gynecologists (ACOG) conducted an online survey in 2016 of its members, and we analyzed results from 230 respondents. RESULTS: We note discrepancies between practice and recommendations amongst surveyed providers: a minority of respondents routinely screen HIV positive patients for trichomoniasis (10.7% "most of the time" 95% confidence interval [CI]: 6.7-15.8, 33.0% "always" 95% CI: 26.5%-40.0%), treat trichomoniasis in HIV positive patients with the recommended dose of metronidazole 500 mg twice a day for 7 days (25.8% 95% CI: 20.0%-32.3%), or retest patients diagnosed with trichomoniasis 3 months after treatment (9.6% 95% CI: 6.1%-14.3R). Only 29.0% (95% CI: 23.0%-35.5%) retreat with metronidazole 500 mg twice a day for 7 days in patients who have failed prior treatment. CONCLUSIONS: Screening for and treatment of trichomoniasis in HIV positive patients, as well as retesting and retreatment for trichomoniasis in the general population appear to be suboptimal. Continuing education for providers is needed for this common but "neglected" STI.

Objective To better understand the knowledge, attitudes and practices of obstetrician-gynecologists with respect to screening and treatment for iron deficiency anemia (IDA). Methods A total of 1,200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population, screening and treatment practices for IDA, and general knowledge about IDA and its risk factors. Results Overall response rate was 42.4%. Thirty-eight percent of respondents screen non-pregnant patients regularly, based on risk factors; 30.5% screen only when symptoms of anemia are present. For pregnant patients, 50.0% of respondents screen patients at their initial visit, while 46.2% screen every trimester. Sixty-one percent of respondents supplement pregnant patients when there is laboratory evidence of anemia; 31.6% supplement all pregnant patients. Forty-two percent of respondents screen post-partum patients based on their risk factors for IDA. However, when asked to identify risk factors for post-partum anemia, slightly more than half of respondents correctly identified young age and income level as risk factors for post-partum anemia; only 18.9% correctly identified pre-pregnancy obesity as a risk factor. Conclusion There are opportunities for increased education on IDA for obstetrician-gynecologists, specifically with respect to risk factors. There also appears to be substantial practice variance regarding screening and supplementation for IDA, which may correspond to variability in professional guidelines. Increased education on IDA, especially the importance of sociodemographic factors, and further research and effort to standardize guidelines is needed.

An estimated 50 million persons worldwide are infected with cysticerci, the larval forms of the Taenia solium tapeworm. Neurocysticercosis can cause seizures, epilepsy, and hydrocephalus, and fatal cases have been reported in the United States in immigrants and in travelers returning from endemic countries. Pregnant women with symptomatic neurocysticercosis present treatment challenges, whereas those with the adult tapeworm infection (i.e., taeniasis) can put their infants and other family members, as well as obstetrician-gynecologists and their staff, at risk for cysticercosis. A questionnaire developed by the American College of Obstetricians and Gynecologists was sent to a representative sample of 1,000 physicians to assess their awareness of T. solium infection and the potential for it to be encountered in an obstetrics and gynecology setting. In total, 31.4% of respondents correctly answered that taeniasis is caused by eating undercooked pork containing T. solium cysts (95% confidence interval [CI] = 26.6-36.5). While only 14.5% (95% CI = 11.0-18.6) of respondents correctly answered that cysticercosis is acquired by ingesting tapeworm eggs shed in human stools, twice that number (30.3%; 95% CI = 25.5-35.3) correctly answered that a mother with taeniasis can cause cysticercosis in her infant. Practicing in a state in which cysticercosis was reportable at the time of the survey was not significantly associated with answering any of the 12 knowledge questions correctly. Overall, knowledge of T. solium infection among U.S. obstetricians-gynecologists is limited. This may result in missed opportunities to diagnose and treat pregnant women with taeniasis, which may put family members and obstetrics clinical staff at risk for cysticercosis.

The Affordable Care Act (ACA) requires states to provide tobacco-cessation services without cost-sharing for pregnant traditional Medicaid-beneficiaries effective October 2010. It is unknown the extent to which obstetricians-gynecologists are aware of the Medicaid tobacco-cessation benefit. We sought to examine the awareness of the Medicaid tobacco-cessation benefit in a national sample of obstetricians-gynecologists and assessed whether reimbursement would influence their tobacco cessation practice. In 2012, a survey was administered to a national stratified-random sample of obstetricians-gynecologists (n = 252) regarding awareness of the Medicaid tobacco-cessation benefit. Results were stratified by the percentage of pregnant Medicaid patients. Chi-squared tests (p <. 0.05) were used to assess significant associations. Analyses were conducted in 2014. Eighty-three percent of respondents were unaware of the benefit. Lack of awareness increased as the percentage of pregnant Medicaid patients in their practices decreased (range = 71.9%-96.8%; P= 0.02). One-third (36.1%) of respondents serving pregnant Medicaid patients reported that reimbursement would influence them to increase their cessation services. Four out of five obstetricians-gynecologists surveyed in 2012 were unaware of the ACA provision that required states to provide tobacco cessation coverage for pregnant traditional Medicaid beneficiaries as of October 2010. Broad promotion of the Medicaid tobacco-cessation benefit could reduce treatment barriers.

OBJECTIVE: To evaluate attitudes and practice patterns of obstetricians related to screening for group B streptococcal colonization and providing intrapartum antibiotic prophylaxis against early-onset neonatal infections with group B streptococcus. STUDY DESIGN: We mailed a survey to 546 members of the American College of Obstetricians and Gynecologists, including members of the Collaborative Ambulatory Research Network and non-Collaborative Ambulatory Research Network members. Stratified random selection was used to generate samples from both of these groups. RESULTS: The survey response rate was 60% for Collaborative Ambulatory Research Network members and 42% for non-Collaborative Ambulatory Research Network members. Of the 206 respondents who reported providing prenatal care, 97% collect screening samples at 35-37 weeks gestational age. Anatomic sites used to collect samples were more variable-62% lower vagina and rectum, 26% lower vagina and perianal skin but not rectum, and 5% include neither the perianal skin nor the rectum. "First line" agents for intrapartum antibiotic prophylaxis were penicillin (71%), ampicillin (27%) and cefazolin (2%). For patients reporting a non-anaphylactic penicillin allergy, drugs used for intrapartum antibiotic prophylaxis were more varied-cefazolin (51%), clindamycin (36%), vancomycin (8%), and erythromycin (5%). For patients undergoing a labor induction starting with a cervical ripening agent, <40% typically give the first dose of intrapartum antibiotic prophylaxis before or at the time of cervical ripening agent administration, and 15% wait until the patient reaches the active phase of labor. CONCLUSIONS: Gaps in knowledge and reported practice related to prevention of early-onset neonatal GBS infections were similar to gaps in implementation of guidelines demonstrated in past studies. New approaches to improve implementation are warranted.

BACKGROUND: Although obstetrician/gynecologists (OB/GYNs) play an important role in sickle cell disease (SCD) screening and patient care, there is little information on knowledge of SCD or sickle cell trait (SCT) or related practices in this provider group. Our objective was to assess SCD screening and prenatal management practices among OB/GYNs. METHODS: Twelve hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (the College)a were invited to complete a mailed survey, of which half (n = 600) belonged to the Collaborative Ambulatory Research Network.b Participants answered questions regarding appropriate target patient groups for prenatal SCD screening, folic acid requirements, practice behaviors and adequacy of their medical school and residency training. RESULTS: A total of 338 CARN members (56.3%) and 165 non-CARN members (27.5%) returned a survey. Of the 503 responders, 382 provided obstetric services and were included in the analyses. Forty percent of these respondents (n = 153) reported seeing at least 1 patient with SCD in the last year. Of these, 97.4% reported regularly screening people of African descent for SCD or SCT, whereas 52.9% reported regularly screening people of Mediterranean descent and 30.1% reported regularly screening people of Asian descent. Only 56.2% knew the correct recommended daily dose of folic acid for pregnant women with SCD. The proportion of respondents that rated training on SCD screening, assessment and treatment as barely adequate or inadequate ranged from 19.7% to 39.3%. CONCLUSIONS: The practice of many OB/GYNs who care for patients with SCD are not consistent with the College Practice Guidelines on the screening of certain target groups and on folic acid supplementation. There may be an opportunity to improve this knowledge gap through enhanced medical education.

PURPOSE: Toxoplasmosis, caused by the parasite Toxoplasma gondii, can have serious impacts on fetal development in the setting of acute maternal primary infection. The American College of Obstetricians and Gynecologists (ACOG) sought to determine current knowledge, practices, opinions, and educational preferences regarding T. gondii infection in pregnancy among ACOG members practicing prenatal care. METHODS: ACOG sent a survey to 1,056 members chosen by stratified random sampling from membership lists, including 370 participants and 686 non-participants in the Collaborative Ambulatory Research Network (CARN). Mailings were sent up to four times to nonresponders. RESULTS: Survey minimum response rates were 40.3 % (CARN) and 19.7 % (non-CARN); response rates adjusted for imputed non-eligibility were 59.7 % (CARN) and 22.6 % (non-CARN). Among providers, 80.2 % had diagnosed no acute maternal T. gondii infections in the past 5 years, 12.7 % correctly identified the screening role of the Toxoplasma avidity test, 42.6 % performed serologic T. gondii screening for at least some asymptomatic pregnant women, and 62.1 % of those who so did used appropriate approaches. Providers in the northeastern United States were 2.02 times more likely to routinely screen than those in the west (p = 0.025) and female providers were 1.48 times more likely than male providers (p = 0.047). The potential educational interventions considered useful by the most practitioners were updated ACOG guidelines on screening (81.4 %) and management (71.7 %) for acute T. gondii infection in pregnancy. CONCLUSIONS: ACOG members would benefit from educational efforts targeted at risk factor counseling and screening approaches.

Although cryptosporidiosis is frequently diagnosed in the U.S., there has been very little assessment of obstetrician-gynaecologist knowledge about this disease. In 2010, we surveyed U.S. obstetricians about the diagnosis, treatment and epidemiology of cryptosporidiosis. Data were examined through univariable analysis and multivariable regression models. Of 1000 obstetrician-gynaecologists surveyed, 431 (43.1%) responded. Only 44.4% of respondents correctly identified that prolonged, intermittent diarrhoea would lead them to consider cryptosporidiosis in a differential diagnosis. Routine ova and parasites (O&P) testing was incorrectly chosen to identify Cryptosporidium in stool by 30.4% of respondents. Questions about nitazoxanide, the only drug approved by the U.S. Food & Drug Administration (FDA) for treatment of cryptosporidiosis, were the most frequently missed questions. Only 9.0% of respondents correctly classified nitazoxanide as an FDA pregnancy Category B drug, and only 5.6% of respondents correctly indicated that FDA approved nitazoxanide for immunocompetent patients aged ≥1 years. Regarding prevention- and control-related knowledge, only 14.1% of respondents correctly indicated that alcohol-based hand sanitizers were not effective at inactivating Cryptosporidium spp., and <10% correctly indicated that cryptosporidiosis is a reportable disease in their state of practice. Multivariable analysis found that ≥19 years in practice was positively associated with O&P diagnostic testing knowledge, while rural and urban non-inner city practice location, compared with suburban practice location, was positively associated with nitazoxanide knowledge. The low level of knowledge among obstetrician-gynaecologists about cryptosporidiosis indicates a need to develop resources for physicians about all aspects of cryptosporidiosis, particularly on diagnosis, treatment and prevention strategies.

OBJECTIVE(S): We examined screening practices and attitudes of obstetricians-gynecologists toward the use of non-combusted tobacco products (chewing tobacco, snuff/snus, electronic cigarettes, and dissolvables) during pregnancy. STUDY DESIGN: The authors mailed a survey in 2012 to 1,024 members of the American College of Obstetricians and Gynecologists, including Collaborative Ambulatory Research Network (CARN)- and non-CARN members. Stratified random selection was used to generate CARN and non-CARN samples. RESULTS: Response rates were 52% and 31% for CARN and non-CARN members, respectively. Of 252 total eligible respondents (those currently providing obstetrical care) 53% reported screening pregnant women at intake for non-combusted tobacco product use all or some of the time, and 40% none of the time. Those reporting that non-combusted products have adverse health effects during pregnancy but are safer than cigarettes ranged from 20% (dissolvables) to 28% (electronic cigarettes), and that the health effects are the same as those of cigarettes from 13% (electronic cigarettes) to 52% (chewing tobacco). Approximately 14% reported that electronic cigarettes have no adverse health effects, while < 1% reported no health effects for the remaining products. Two-thirds wanted to know more about the potential health effects of non-combusted tobacco products; only 5% felt fully informed. CONCLUSIONS: A large proportion of obstetrician-gynecologists reported never or inconsistently screening their pregnant patients for use of non-combusted tobacco products. Responses regarding the harms of these products relative to cigarettes were mixed and most respondents wanted more information. Development and dissemination of guidance for providers is needed improve decision making regarding non-combusted tobacco products.

OBJECTIVE: To assess barriers to and quality of care received by diabetic pregnant women from obstetrician-gynecologists. STUDY DESIGN: A questionnaire was mailed to 1,000 representative practicing Fellows of the American College of Obstetricians and Gynecologists; 74 did not treat pregnant patients and 510 (55.1%) returned completed surveys. Respondents were divided into 3 groups: maternal-fetal medicine specialists, physicians with high minority/low insurance patient populations, and physicians with low minority/ high insurance patient populations. RESULTS: Reported preconception and prenatal care was generally consistent with guidelines. Regarding gestational diabetes mellitus patients the 3 physician groups differed in assessing postpartum glycemic status, counseling about lifestyle changes, and counseling patients to consult a doctor before their next pregnancy. Patient demographics and perceived barriers to care were similar between maternal-fetal medicine specialists and physicians with high minority/low insurance patient populations. These two physician groups were more likely to agree that lack of educational materials, arranging specialist referrals, patient compliance with recommendations, and patients' ability to afford healthful food were barriers to quality care. CONCLUSION: According to physician self-report, pregnant diabetic patients with access to an obstetrician receive quality care regardless of insurance status. Postpartum care is more variable. Physicians with high minority/low insurance patient populations may lack access to resources.

BACKGROUND: Late preterm birth (LPTB) accounts for most preterm births and has been increasing, associated with increases in cesarean sections and inductions at this gestational age. METHODS: A self-administered survey, consisting of questions about opinions, knowledge, and practices regarding LPTB, was mailed to 1232 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in Practice in May-July 2010. RESULTS: Surveys were returned by 520 practicing obstetricians. Two thirds of respondents correctly defined LPTB (34-36 weeks completed gestation). Most responding physicians (87%) were aware of the evidence regarding morbidity and mortality of infants born at 34-36 weeks; 81% considered such evidence sufficient to make a clinical judgment. Although 84% were concerned about long-term health problems in these infants, many disagreed that LPTB infants were at increased risk of long-term neurodevelopmental outcomes. Most agreed that the increase in LPTB in the United States is due to increasing rates and complications of multifetal pregnancies and maternal disorders. Almost all responding physicians agreed that certain clinical indications (e.g., severe preeclampsia, placental abruption, premature rupture of the membranes [PROM]) were appropriate reasons for early delivery, and most disagreed with delivering late preterm infants for logistical reasons or convenience. Half of responding physicians reported that concerns about malpractice risks contribute to their decision to induce labor or perform a cesarean section at 34-36 weeks. CONCLUSIONS: Many obstetricians underestimate long-term neurodevelopmental outcomes among infants born late preterm and may have a lower threshold to deliver some infants late preterm for indications that are not evidence based. Additional educational efforts regarding LPTB are needed.

This study examined the impact of the Centers for Disease Control and Prevention's (CDC's) One Test. Two Lives. (OTTL) campaign on key outcomes related to CDC's revised HIV testing recommendations and the use of the campaign materials. Data from three cross-sectional surveys were used to assess the effect of OTTL on Obstetricians/Gynecologists' (OB/GYN) HIV knowledge and practice. A 2-year combined sample of 500 OB/GYNs completed DocStyles, a Web-based survey for physicians, and 575 American College of Obstetricians and Gynecologists (ACOG) Fellows completed an ACOG survey. The surveys were similar in focus but did not contain the same items. Data were analyzed using cross-tabulations, chi(2) analyses, and logistic regression. There was a 20% recall of exposure to OTTL with DocStyles and 25% with ACOG. DocStyles respondents reporting having seen OTTL materials were significantly more likely to report awareness of CDC's recommendations [chi(2)(1) = 25.43, P < .001] and include HIV testing as a regular screening test for all patients [chi(2)(1) = 4.98, P < .05]. ACOG respondents not using the materials indicated high levels of willingness to use the materials-63.0 to 71.5%, depending on the material. Of the ACOG sample, 68.1% correctly answered the knowledge items regarding the recommendations. However, a significant relationship between correct knowledge and campaign exposure was not found. Overall, results suggest that OTTL is instrumental in raising awareness and implementation of the testing recommendations and plays an important role in facilitating HIV testing practices with obstetric providers and their patients.

OBJECTIVE: We examined practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic. STUDY DESIGN: From February-May 2010, a survey was sent to a random sample of members of the American College of Obstetricians and Gynecologists involved in obstetric care. RESULTS: Obstetrician-gynecologists varied in their adherence to 2009 H1N1 influenza public health recommendations. Nearly all reported prescribing antiviral medications to pregnant women with suspected influenza. Most obstetrician-gynecologists reported using preventive practices in the outpatient setting to reduce exposure of well patients to ill ones. A wide range of responses was provided regarding postpartum infection control practices, suggesting lack of awareness of, disagreement with, or difficulty adhering to these recommendations. CONCLUSION: Obstetrician-gynecologists reported that they adhered to some recommendations related to 2009 H1N1 influenza, but not to others. These data provide insight into strategies for development and dissemination of recommendations in a future pandemic.

OBJECTIVE: To better understand the current evaluation of unexplained menorrhagia by obstetrician-gynecologists and the extent to which a bleeding disorder diagnosis is being considered in this population. STUDY DESIGN: A total of 1200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population and their evaluation of patients with unexplained menorrhagia. RESULTS: The overall response rate was 42.4%. Eighty-two percent of respondents reported having seen patients with menorrhagia caused by a bleeding disorder. Seventy-seven percent of physicians reported they would be likely or very likely to consider a bleeding disorder as causing menorrhagia in adolescent patients; however, only 38.8% would consider bleeding disorders in reproductive age women. CONCLUSION: The current data demonstrate that obstetrician-gynecologists seem to have a relatively high awareness of bleeding disorders as a potential underlying cause of menorrhagia.

OBJECTIVE: To assess knowledge, attitudes, and practices of obstetrician-gynecologists (ob-gyns) regarding vaccination of pregnant women during the 2009 H1N1 pandemic. METHODS: From February to July 2010, a self-administered mail survey was conducted among a random sample of American College of Obstetricians and Gynecologists (the College) members involved in obstetric care. To assess predictors of routinely offering influenza vaccination, adjusted prevalence ratios and 95% confidence intervals (CIs) were calculated from survey data. RESULTS: Among 3,096 survey recipients, 1,310 (42.3%) responded to the survey, of whom 873 were eligible for participation. The majority of ob-gyns reported routinely offering both seasonal and 2009 H1N1 influenza vaccination to their pregnant patients (77.6% and 85.6%, respectively) during the 2009-2010 season; 21.1% and 13.3% referred patients to other specialists. Reported reasons for not offering vaccination included inadequate reimbursement, storage limitations, or belief that vaccine should be administered by another provider. Seasonal and 2009 H1N1 influenza vaccination during the first trimester was not recommended by 10.6% and 9.6% of ob-gyns, respectively. Predictors of routinely offering 2009 H1N1 influenza vaccine included: considering primary care and preventive medicine a very important part of practice (adjusted prevalence ratio 1.2, CI 1.01-1.4); observing serious conditions attributed to influenza-like illness (adjusted prevalence ratio 1.1, CI 1.02-1.1); personally receiving 2009 H1N1 influenza vaccination (adjusted prevalence ratio 1.2, CI 1.1-1.4); and practicing in multispecialty group (adjusted prevalence ratio 1.1, CI 1.1-1.2). Physicians in solo practice were less likely to routinely offer influenza vaccine (adjusted prevalence ratio 0.8, CI 0.7-0.9). CONCLUSION: Although most ob-gyns routinely offered influenza vaccination to pregnant patients, vaccination coverage rates may be improved by addressing logistic and financial challenges of vaccine providers. LEVEL OF EVIDENCE: III.

Chagas disease affects an estimated 300,000 people in the United States, and as many as 300 congenital infections are estimated to occur annually. The level of knowledge about Chagas disease among obstetricians-gynecologists in the United States has not been assessed. The American College of Obstetricians and Gynecologists surveyed a representative sample of 1,000 members about Chagas disease. Among 421 respondents, 68.2% (95% confidence interval [CI] = 63.5-72.6) described their knowledge level about Chagas disease as "very limited." Only 8.8% (95% CI = 6.2-12.0) knew the risk of congenital infection, and 7.4% (95% CI = 5.1-10.4) were aware that both acute and chronic maternal infections can lead to congenital transmission. The majority of respondents (77.9%; 95% CI = 73.5-81.9) reported "never" considering a diagnosis of Chagas disease among their patients from endemic countries. Most of those who did consider the diagnosis did so "rarely." Knowledge of Chagas disease among obstetricians-gynecologists in the United States is limited. Greater awareness may help to detect treatable congenital Chagas cases.

OBJECTIVE: To assess opinions, knowledge, and informational resources of obstetrician-gynaecologists regarding the safety of medication use during pregnancy. METHODS: A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 58%. Of these, 305 respondents provide both routine gynecologic and obstetric care and are the focus of the study. There was wide variation in obstetrician-gynaecologists' assessments of the safety for the foetus of medications ranging from aspirin to valproic acid. The Physicians' Desk Reference was most frequently (75%) cited as a source of information about medication safety. Forty-two percent of obstetrician-gynaecologists selected lack of sufficient information on medications as the greatest barrier to counselling pregnant women about their use, while only 4% selected lack of access to information as the greatest barrier. Most (79%) obstetrician-gynaecologists indicated they would be willing to participate in pregnancy exposure registries, but far fewer (24%) reported having done so. CONCLUSION: These results emphasise the need for safety information about the effects of medication use during pregnancy and suggest that pregnancy exposure registries are underutilised.

OBJECTIVE: To assess screening and treatment patterns of obstetrician-gynecologists regarding medication use during pregnancy. METHODS: A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 58%. Most respondents reported always asking pregnant patients about use of over-the-counter (OTC) (86%) and prescription (98%) drugs; 24% reported not always asking about alternative medications. Far fewer reported always asking nonpregnant patients about use of alcohol (67%), illegal drugs (51%) and OTC medications (52%) than pregnant patients. Two-fifths (41%) reported prescribing a medication during pregnancy for which they had insufficient information about potential effects on the fetus; nearly half (47%) reported that there are medical conditions for which they would like to prescribe medications but do not due to insufficient safety information. Physician responses indicate that they are less likely to refer pregnant than nonpregnant patients to a specialist for treatment of certain conditions. CONCLUSIONS: These results indicate that obstetrician-gynecologists sometimes prescribe medications for pregnant patients under less than optimal conditions and emphasize the importance of generating up-to-date information on effects of medications during pregnancy and having it readily available to health care providers.

OBJECTIVE: To describe associations between dissemination of educational materials and U.S. obstetrician/gynecologists' prevention and management of obesity in nonpregnant patients. METHODS: Cross-sectional surveys mailed to 806 and 787 members of the American College of Obstetrician and Gynecologists (ACOG) Collaborative Ambulatory Research Network in February-April 2005 and March-May 2007, respectively, before and after dissemination of ACOG Committee Opinions. RESULTS: Compared with participants in 2005 (n = 437), the proportion of participants in 2007 (n = 433) who reported they would screen nonpregnant adult patients using body mass index (BMI), counsel patients most of the time about physical activity, and ever prescribed weight loss medications increased from 84% to 91%, 48% to 55%, and 40% to 48%, respectively (p < 0.05 for all comparisons). In contrast, reported frequencies of counseling or referring nonpregnant patients for weight control were not significantly different (p > 0.05). In 2007, 33% reported counseling most of the time, and 70% reported referral at least sometimes. A lower proportion of 2007 participants indicated it was likely or very likely that patients would follow advice about physical activity or diet or they can help patients lose weight (p < 0.01 for all comparisons). For adolescent patients, 43% and 24% of participants reported counseling most of the time about physical activity and sedentary activity, respectively. Reported frequency of counseling patients about activity, counseling adult patients about weight control, and prescribing medications was higher among obstetrician/gynecologists who reported reading the Committee Opinions. CONCLUSIONS: Despite decreased optimism about the likelihood of patients following advice, modest improvements occurred in some obstetrician/gynecologists' obesity prevention practices between 2005 and 2007.

Parasites from raw fish can lead to a wide range of clinical manifestations and can be challenging to treat in pregnancy as result of medication exposure of the foetus. We surveyed obstetrician-gynecologists (ob-gyns) in the U.S. to determine their knowledge about the consumption of raw fish during pregnancy. In March 2007, a questionnaire was mailed to members of the American College of Obstetricians and Gynecologists (ACOG) randomly selected to represent all members. Non-responding physicians were sent two additional mailings. Of the 606 ACOG members surveyed, 305 (50%) responded. Most (82%) respondents indicated that eating raw fish is not safe during pregnancy. However, few (19%) knew that thorough freezing kills parasites in fish. Nearly all (94%) respondents thought that parasitic infections can be more challenging to treat in pregnancy. U.S. ob-gyns believe that eating raw fish during pregnancy is not safe; most would benefit from information about how to prevent infection and about treatment.

Summary: Toxoplasmosis in pregnant women can lead to congenital disease with severe neurological and ocular complications in the foetus. In 2006, we surveyed US obstetrician-gynaecologists to determine their knowledge and practices about toxoplasmosis prevention and testing. Questionnaires were mailed (four mailings) to a random sample of 1200 of the 33 354 members of the American College of Obstetricians and Gynecologists (ACOG). Of the 1200 surveyed, 502 (42%) responded. The respondents were similar to all ACOG members by gender, region of the country and practice type (P > 0.5), and age (respondents were slightly younger, mean 46 years versus 47 years). To prevent toxoplasmosis, most respondents indicated that they counsel pregnant women about cat litter (99.6%), but fewer counselled about eating undercooked meat (77.6%), handling raw meat (67.4%), gardening (65.4%) or washing fruits and vegetables (34.2%). Many (73.2%) respondents were not aware that some Toxoplasma IgM tests have had a high false positive rate, and most (91.2%) had not heard of the avidity test, which can help determine the timing of Toxoplasma gondii infection in relation to pregnancy. There is a need for more education about T. gondii serological testing, particularly the Toxoplasma avidity test. US obstetrician-gynaecologists are providing beneficial counselling to their patients, but could provide more information about undercooked meat and soil risks.

A survey regarding management of obesity in pregnancy was mailed to 787 practising members of the American College of Obstetricians and Gynecologists (ACOG); 433 responded of whom 353 practised obstetrics. Most (79.2%) had read ACOG Committee Opinion, 'Obesity in Pregnancy,' and rated it helpful (68.6%) or very helpful (17.2%). Most responding physicians (91.2%) use BMI to assess their patients weight status; fewer (63.4%) use pre-pregnancy BMI to modify their pregnancy weight gain recommendation. Having read the Committee Opinion and being a woman were independent factors associated with using pre-pregnancy BMI. Responding physicians that had read the Committee Opinion were more knowledgeable about obesity-related pregnancy complications; but even among those physicians, only 32.2% were aware that maternal obesity is a risk factor for fetal neural tube defects. The responding physicians appeared well-versed on appropriate practice for caesarean delivery for obese patients whether they had read the Committee Opinion or not.

We sought to describe current attitudes and practices of obstetrician-gynecologists regarding use of progesterone and prevention of preterm birth. A self-administered survey was mailed to American College of Obstetricians and Gynecologists Fellows and Junior Fellows in Practice in March to May 2007. The survey consisted of 36 questions, including respondents' demographic characteristics, preterm birth risk factor knowledge and screening practices, and use of progesterone for the prevention of preterm birth. The response rate was 52% ( N = 345); most respondents were general obstetrician-gynecologists (89%). Many (74%) reported recommending or offering progesterone for prevention of preterm birth. Almost all (93%) reported use for the indication of previous spontaneous preterm birth. However, many also reported use for other indications such as dilated/effaced cervix (37%), short cervix on ultrasound (34%), and cerclage (26%). These results suggest that most obstetricians recommend or offer progesterone to prevent preterm birth for women with a previous spontaneous preterm birth and many also offer it for women with other high-risk obstetric conditions.

BACKGROUND: Maternal infection during pregnancy is a well-recognized cause of birth defects and developmental disabilities, as well as an important contributor to other adverse pregnancy outcomes. The objective of the present survey was to gain information about the knowledge, attitudes, and practices of obstetrician/gynecologists regarding prevention of infections during pregnancy. METHODS: A survey was mailed to 606 Collaborative Ambulatory Research Network (CARN) members of the American College of Obstetricians and Gynecologists (ACOG) (approximately 2% of membership). CARN members were sampled to demographically represent ACOG. RESULTS: Of the 606 eligible respondents, surveys were received from 305 (response rate: 50%). Most obstetrician/gynecologists knew that specific actions by pregnant women could reduce the risk of infection. Seventy-nine to eighty-eight percent reported counseling pregnant women about preventing infection from Toxoplasma gondii, hepatitis B virus, and influenza, 50%-68% about varicella-zoster virus, Listeria monocytogenes, and Parvovirus B19, and <50% about cytomegalovirus, Bordetella pertussis, and lymphocytic choriomeningitis virus. The majority reported time constraints were a barrier to counseling, although most reported educational materials would be helpful. CONCLUSIONS: Knowledge was accurate and preventive counseling was appropriate for some infections, but for others it could be improved. Further studies are needed to identify strategies to increase preventive counseling.