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Am J Perinatol 2023; 40(01): 001-008
DOI: 10.1055/a-1877-9970
SMFM Fellowship Series Article

Survey of Obstetric Providers to Assess the Knowledge and Management of a Reported Penicillin Allergy in Pregnant Women

Jennifer J. M. Cate 
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Martina Burn
2   Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Jason Kwah
3   Section of Rheumatology, Allergy, and Immunology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
,
Jane Liao
4   Department of Medicine, Yale School of Medicine, New Haven, Connecticut
,
Jessica Illuzzi
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Uma Reddy
2   Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Moeun Son
2   Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
› Author Affiliations Funding None.
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Abstract

Objective Penicillin allergy is the most commonly reported drug allergy in the United States; however, less than 10% of individuals labeled with a penicillin allergy are truly allergic. A reported penicillin allergy in pregnancy is associated with adverse maternal and perinatal outcomes. Despite recommendations for penicillin allergy testing in pregnancy, limited literature regarding obstetric providers' comfort and knowledge in addressing penicillin allergy and referral patterns exists. The objective of this study is to survey obstetric providers to assess their clinical practice patterns and baseline penicillin allergy knowledge, identify potential knowledge gaps in the management of pregnant patients with reported penicillin allergy, and measure the impact of an educational intervention on provider knowledge and practice patterns.

Study Design An anonymous, electronic 23-question survey administered to all obstetric providers at a single academic medical center assessed obstetric provider characteristics, self-reported antibiotic practice patterns, and antibiotic allergy knowledge before (June 19, 2020) and after (September 16, 2020) a penicillin allergy educational intervention, which consisted of multiple small-group educational sessions and a culminating departmental educational session. Discrete knowledge comparison by provider type and experience level of pre- and postintervention was performed using chi-square tests.

Results Of 277 obstetric providers invited, 124 (45%) responded preintervention and 62 (22%) postintervention. In total, 27% correctly identified the percentage of patients labeled penicillin allergic who would tolerate penicillins, 45% identified cephalosporin cross-reactivity, 59% understood penicillin allergies can wane, and 54% identified penicillin skin testing (PST) as a valid allergy verification tool. Among 48 respondents who attended educational sessions and responded postintervention, their knowledge of penicillin allergy waning (79% preeducation vs. 98% posteducation, p < 0.01) and PST as a valid tool for penicillin allergy verification (50% preeducation vs. 83% posteducation, p < 0.01) improved.

Conclusion Knowledge gaps related to penicillin allergy exist among obstetric providers. Educational initiatives may improve provider knowledge, help in the identification of patients requiring penicillin allergy evaluation, and reduce referral barriers.

Key Points

  • Obstetric providers lack adequate knowledge of penicillin allergy.

  • Educational interventions can improve discrete knowledge.

  • Limited knowledge is a barrier to allergy referral for penicillin allergy delabeling.

Keywords

allergists - allergy referral - penicillin allergy - skin testing - penicillin allergy delabeling

Presentation

This study was presented at the Society for Maternal Fetal Medicines' (SMFM's) 41st Annual Pregnancy Meeting, virtual conference, January 25–31, 2021.


Supplementary Material



Publication History

Received: 05 November 2021

Accepted: 03 June 2022

Accepted Manuscript online:
16 June 2022

Article published online:
12 September 2022

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