Listeriosis in Pregnancy: Practitioners' Food Safety Counselling Practices to Pregnant Women.

OBJECTIVE: The relative risk of invasive listeriosis in pregnant women is approximately 20 times greater than the general population, and listeriosis during pregnancy can have negative consequences for pregnant women, their fetuses, and their newborns. Health care providers are valuable sources of information, but published data suggest that most providers are unaware of the risk factors for listeriosis or its propensity for pregnant women, and they do not counsel their pregnant patients about risks. The objective of this study was to determine knowledge and practices of Canadian perinatal care providers on food safety counselling to pregnant women. METHODS: An anonymous bilingual online questionnaire that sought information about awareness, knowledge of risk factors, practices for counselling pregnant women, and practitioners' learning needs with regard to listeriosis was sent to 3199 nurses, midwives, family physicians, and obstetrician/gynaecologists in Canada, with a response rate of 24.4%. RESULTS: Most respondents had heard of listeriosis, provided prenatal care, and attended deliveries. Rates of awareness of listeriosis were the same among professions and were independent of years in practice, whether practice was urban or rural, and province. One third of the respondents (35.7%) were aware that listeriosis was more common in pregnant women; a minority (18.7%) correctly identified the incubation period for listeriosis and the stage in pregnancy in which women are at highest risk (30.4%). Those respondents who did not counsel women about the risks of listeriosis during pregnancy reported a lack of information or knowledge as the main reason. CONCLUSION: Advising pregnant women about behaviours and lifestyle habits to prevent infectious diseases remains important, and information about preventive practices needs to be complete and adequate. The health care providers who participated in this study did express a clear need for information related to food safety during pregnancy and listeriosis, as supported by their lack of knowledge in some areas. If that lack is remedied, the knowledge gained could improve counselling practices.

Listeriosis in pregnancy: survey of British Columbia practitioners' knowledge of risk factors, counseling practices, and learning needs.

OBJECTIVE: To determine the knowledge, counseling practices, and learning needs of practitioners in British Columbia regarding risk factors for listeriosis in pregnancy. DESIGN: A 1-page, mailed, self-administered, anonymous questionnaire. SETTING: British Columbia. PARTICIPANTS: A total of 827 practitioners (614 family physicians, 93 midwives, and 120 family practice residents) were sent the questionnaire. MAIN OUTCOME MEASURES: Awareness of listeriosis, knowledge of the risk factors for listeriosis, practices for counseling pregnant women, practitioners' learning needs, and provider and practice characteristics. RESULTS: A total of 340 practitioners (41%) completed the questionnaire. While most (88%) physicians and midwives had heard of listeriosis, few (18%) were aware that infection was more common during pregnancy. One-third (33%) of practitioners counseled pregnant women about the risk factors for listeriosis. The main reasons for not providing such counseling were lack of knowledge and the perception that listeriosis was rare and not an important concern for pregnant women. Rates of counseling were highest among midwives (84%) and lowest among physicians practising outside the Lower Mainland of British Columbia (12%). Of those practitioners providing prenatal care, 47% counseled pregnant women about the risks of unpasteurized milk and 41% counseled women about the risks of consuming soft cheese; few counseled about the risks of consuming deli meat or raw hot dogs (25%), unwashed fruit and vegetables (12%), or refrigerated smoked seafood (6%). CONCLUSION: Most prenatal care providers in British Columbia are unaware of the risk factors for listeriosis or its propensity for pregnant women and do not counsel their pregnant patients about these risks.

Evidence-based prenatal care: part II. Third-trimester care and prevention of infectious diseases.

All pregnant women should be offered screening for asymptomatic bacteriuria, syphilis, rubella, and hepatitis B and human immunodeficiency virus infection early in pregnancy. Women at increased risk should be tested for hepatitis C infection, gonorrhea, and chlamydia. All women should be questioned about their history of chickenpox and genital or orolabial herpes. Routine screening for bacterial vaginosis is not recommended. Influenza vaccination is recommended in women who will be in their second or third trimester of pregnancy during flu season. Women should be offered vaginorectal culture screening for group B streptococcal infection at 35 to 37 weeks' gestation. Colonized women and women with a history of group B streptococcal bacteriuria should be offered intrapartum intravenous antibiotics. Screening for gestational diabetes remains controversial. Women should be offered labor induction after 41 weeks' gestation.

Evidence-based prenatal care: Part I. General prenatal care and counseling issues.

Effective prenatal care should integrate the best available evidence into a model of shared decision making. Pregnant women should be counseled about the risks of smoking and alcohol and drug use. Structured educational programs to promote breastfeeding are effective. Routine fetal heart auscultation, urinalysis, and assessment of maternal weight, blood pressure, and fundal height generally are recommended, although the evidence for these interventions is variable. Women should be offered ABO and Rh blood typing and screening for anemia during the first prenatal visit. Genetic counseling and testing should be offered to couples with a family history of genetic disorders, a previously affected fetus or child, or a history of recurrent miscarriage. All women should be offered prenatal serum marker screening for neural tube defects and aneuploidy. Women at increased risk for aneuploidy should be offered amniocentesis or chorionic villus sampling. Counseling about the limitations and risks of these tests, as well as their psychologic implications, is necessary. Folic acid supplementation beginning in the preconception period reduces the incidence of neural tube defects. There is limited evidence that routine use of other dietary supplements may improve outcomes for the mother and infant.

Pregnancy planning guide. Evidence-based information for prospective parents.

PROBLEM BEING ADDRESSED: Pregnancy planning is inadequately supported by existing information and materials. OBJECTIVE OF PROGRAM: To design and pilot-test a new way to help women plan their pregnancies and incorporate important evidence-based information directly into their planning. To evaluate the content of the new Pregnancy Planning Guide and women's satisfaction with it. MAIN COMPONENTS OF PROGRAM: The Pregnancy Planning Guide combines a rotating gestational wheel surrounded by information about time-specific events in pregnancy with evidence-based information about common concerns during pregnancy. The guide is designed to be used as a quick reference for women and their partners; it highlights issues to be discussed at greater length with maternity caregivers. The guide was first evaluated for content validity by 27 experienced maternity caregivers and then revised. The revised version was given to 108 women of childbearing age along with a survey to assess their satisfaction with the guide and the extent to which they thought it was useful. CONCLUSION: The Pregnancy Planning Guide is useful for women planning pregnancy. It should promote increased use of folic acid in the periconception period and a greater understanding of when birth is likely to occur.