Tough Suzanne C, Clarke Margaret, Hicks Matt, Cook Jocelynn
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.
Department of Paediatrics, University of Calgary, Calgary AB.
J Obstet Gynaecol Can. 2006 Sep;28(9):780-788. doi: 10.1016/S1701-2163(16)32259-9.
To determine the pre-conception practices among obstetrician-gynaecologists and family physicians in Canada.
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.
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.
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.
确定加拿大妇产科医生和家庭医生的孕前诊疗行为。
在2001年10月至2002年5月期间，向加拿大皇家内科医师和外科医师学院或加拿大妇产科医师协会的现任成员中随机抽取的全国范围内的妇产科医生（n = 539）和家庭医生（n = 2378）邮寄了一份调查问卷。
妇产科医生的回复率为41.7%，家庭医生的回复率为31.1%。超过85%的医生经常与育龄妇女讨论避孕和巴氏试验，但经常详细了解饮酒史的医生不到60%。不到50%的医生经常与育龄妇女讨论以下内容：体重管理、工作压力、心理健康、成瘾史或孕期使用药物的风险问题。询问性虐待或情感虐待史的医生不到15%。与妇产科医生相比，家庭医生更有可能与育龄妇女讨论心理健康（41.1%对28.1%）、抑郁症（44.5%对29.0%）和饮酒史（59.8%对47.9%）（所有P<0.05）。与家庭医生相比，妇产科医生更有可能与未怀孕的育龄妇女讨论叶酸（57.8%对47.2%）、性虐待（18.2%对10.8%）、吸烟（56.0%对46.1%）和药物使用（45.8%对35.9%）（所有P<0.05）。
孕前筛查存在未抓住的机会，未能识别出生殖健康状况欠佳、有不良受孕、妊娠和分娩结局风险的女性。对识别有风险女性的医生培训，将有助于通过转介到适当的治疗和资源，加强一级和二级预防工作。
