Discussion Questions

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  Why is this topic worthwhile?

  
  
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  What are the advantages and disadvantages of the study design?

  
  
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  What were the primary and secondary objectives of the study?

  
  
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  Did the research assistant provide appropriate information to participants?

  
  
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  Was the proper clinic employee surveyed?

  
  
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  What is the clinical impact of this study?

How early in a pregnancy should the patient be seen? Consider that in an effort to reduce the prevalence of prematurity, low birthweight, major birth defects, and pregnancy complications, the Centers for Disease Control and Prevention recommends preconception care. The agency notes that significant problems can occur by the 11th or 12th week of pregnancy. It also states that 11% of pregnant women smoke, and 10% drink alcohol. As for women with the potential to become pregnant, 69% do not take folic acid supplements, 31% are obese, 4% have preexisting medical conditions, and 3% take medications that are recognized teratogens. Obviously, then, women who are already pregnant should be seen as soon as possible. Yet, Nettleman and colleagues found that a considerable number of practices delay that essential first appointment.

Theoretically, office-based delays in obtaining prenatal care should not occur. In reality, this may not be the case, even though the first weeks of pregnancy are among the most crucial. This period, during which organogenesis takes place, presents a unique opportunity for intervention. However, late presentation to the obstetrician’s office often prevents patients from receiving care in the early weeks of pregnancy. Whether late presentation is the fault of the patient or of the office is a subject that had never been systematically studied until Nettleman and colleagues surveyed physicians’ offices. The topic is important because the results have the potential to influence obstetric practices across the country—from community-based practices to large academic institutions. If the office is a factor in postponed prenatal care, routines can be altered to eliminate the delay, optimizing patient care.