BALTIMORE -- The need for postnatal immunization appears to be an afterthought in prenatal care.
BALTIMORE, Aug. 13 -- The need for postnatal immunization appears to be an afterthought in obstetric prenatal care.
Routine prenatal care only infrequently includes informing pregnant women about immunizations a baby will need, an oversight that may contribute to parents' vaccine safety concerns and immunization delays, researchers here said.
In a random sample survey, just 22% of obstetric practices reported giving pregnant women information on routine childhood immunizations and about 13% of first-time mothers seen at pediatric practices got this information, found Ann Marie Nvar, M.H.S., of Johns Hopkins, and colleagues.
But 80% of hospitals surveyed informed women about childhood immunizations during childbirth classes, they reported in the September issue of the American Journal of Preventive Medicine.
"Prenatal visits are a missed opportunity for providing education about infant immunizations," they wrote. "Incorporating immunization education into routine obstetric prenatal care may increase maternal knowledge of infant vaccines and reduce delayed immunization."
The American Academy of Pediatrics recommends a pediatric prenatal visit for all pregnant women, which is suggested to include discussion of breastfeeding, car safety, and other topics, though not immunizations.
However, some small studies have suggested that immunization education for pregnant women improves timely vaccination of their children, which has been a concern, Nvar and colleagues said. One-third of infants in 2003 had not received all recommended immunizations by age two years.
In the current study, the researchers conducted a telephone survey of 71 office-based obstetric practices and 85 office-based pediatric practices, randomly selected from the American Medical Association's Masterfile.
Among pediatric practices, 78% offered prenatal visits and 55% of these included discussion of childhood immunizations. But, they reported that on average only about 30% of first-time mothers received a prenatal visit.
Among obstetric practices, only 32% provided pregnant women information on the hepatitis B vaccine that is administered to children within hours of birth and just 23% offered information on other routine childhood immunizations.
Notably, though, 54% of obstetric practices that did not discuss immunizations did offer information on topics such as car seats, pets, and circumcision.
The majority of obstetric practices did refer pregnant women to hospital-based childbirth education classes (85%).
Among the 51 participating hospitals (of the 78 where women from the obstetric practices delivered), 80% included information on routine childhood immunizations in their classes. For 45%, this included specific information on the hepatitis B vaccine.
"With improved attendance and resources, hospital-based prenatal classes can be an avenue for prenatal immunization education," Nvar and colleagues wrote.
Hospital-based classes may not be the ideal solution because about a third of mothers do not attend them, and the class format typically focuses on labor and delivery, they added.
Furthermore, improving efforts at these classes could be a case of preaching to the choir. Women who attend prenatal classes are more likely to be those with characteristics associated with higher immunization rates -- white, not poor, more educated, and married.
However, the researchers found that 65% of obstetric practices that did not offer immunization information would be willing to do so.
"Although opportunities exist for educating mothers about vaccines during the prenatal period, including the pediatric prenatal visit, routine obstetric care, and hospital-based prenatal education classes, these opportunities may be underutilized," they concluded.
The investigators acknowledged that many of the respondents in their survey were office staffers rather than physicians, which could have biased evaluation of physician education practices.
But, there were no significant differences in responses at obstetric practices by whether the respondent was in direct patient contact or a member of the office staff (P=0.09 for information on the hepatitis B vaccine and P=0.11 for information on other childhood vaccines). The same was true at pediatric practices (P=0.40 for reporting that immunizations were discussed regularly).