A survey of obstetrician-gynecologists on their patients' use of tobacco and other drugs during pregnancy

Objective This survey was conducted to assess the knowledge, beliefs and practice behaviors of obstetrician-gynecologists concerning their patients' prenatal use of tobacco and other drugs. Methods We developed a 32-item questionnaire which the American College of Obstetricians and Gynecologists mailed to a sample of 1000 members throughout the USA. A total of 604 questionnaires were returned (60%). Descriptive statistics, prevalence rates and prevalence rate ratios were calculated, and stratified analyses were performed in some cases in order to control for the possible confounding effects of age and gender. Results Most respondents (98%) reported questioning their prenatal patients at the first visit about tobacco use, with only one in nine asking at each prenatal visit. Ninety-five per cent of respondents reported that they discussed adverse effects and advised cessation for patients who screened positive for smoking; 38% reported always providing self-help materials; and 22% reported referrals to cessation workshops. Fewer respondents (87%) reported asking their patients about drug use. Among women reporting other drug use, 97% of clinicians discussed adverse effects, and 95% advised abstinence. Forty-five per cent reported that they referred patients for treatment, and one-third reported performing periodic drug screens. Respondents graduating after 1989, female clinicians and clinicians who judged their medical school training on substance use as excellent or very good were more likely to adhere to current practice guidelines on smoking and illicit drug use. Conclusions While screening of prenatal patients for tobacco use and other drug use was reported by survey respondents, providing or arranging for interventions for those screening positive was less often reported.