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.

Study design: 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.

Conclusion: 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.

Figure 1. The percentage of “yes” respondents to the survey question, “Do you routinely discuss this issue as part of prenatal care?”

Environmental exposures routinely discussed by less than 50% of survey respondents are shaded light grey. VOCs  =  volatile organic compounds; PCBs  =  polychlorinated biphenyls; BPA  =  bisphenol-A.