Link found between delayed prenatal care and congenital syphilis rates

Link found between delayed prenatal care and congenital syphilis rates | Image Credit: © Jsyhin_stas - © syhin_stas - stock.adobe.com.

There is an association between delays in testing and treatment after diagnosis and congenital syphilis rates, according to a recent study presented at the Infectious Disease Society for Obstetrics and Gynecology 2024 Annual Meeting.¹

Congenital syphilis, linked to Treponema Pallidum transmission from the mother to the fetus during pregnancy, has grown significantly in the previous decade. This includes a 574% increase in the United States and a 106% increase in Louisiana. However, routine screening and adequate treatment can be employed to reduce vertical transmission.

Data has indicated a gap in care, with minority groups and individuals with a low socioeconomic status (SES) primarily impacted. Therefore, investigators conducted a single large regional hospital system analysis hypothesizing the odds of delivering an infant with congenital syphilis would be increased among minority and low SES populations.

The study was conducted using data from January 2015 to April 2023. Participants included pregnant women aged 15 to 45 years delivering at the Ochsner Health System following established prenatal care. Those with no prenatal visits, incomplete syphilis testing, serofast state, or incomplete delivery data were excluded.

Congenital syphilis was the primary outcome of the analysis, with congenital syphilis cases compared to non-cases. The administration of penicillin G because of clinical suspicion was used to identify congenital syphilis cases.

There were 248 individuals who received at least 1 dose of penicillin G during pregnancy included in the analysis, 155 of whom had congenital syphilis while 93 were controls without congenital syphilis. The odds of delivering in a non-academic hospital were increased 3-fold among congenital syphilis cases vs controls.

A higher median gestational week at syphilis treatment was reported among cases compared to controls, but this increase was not significant. Additionally, the time between treatment and diagnosis was increased by 4 days among congenital syphilis mothers vs those without congenital syphilis.

Characteristics not associated with congenital syphilis included race and ethnicity, payor status, area of deprivation index, other sexually transmitted infection history, and number of prenatal care. These results indicated an association between delays in testing and treatment after diagnosis and congenital syphilis.

Notably, there has been a rise in maternal syphilis cases between 2016 and 2022, as reported by the Centers for Disease Control and Prevention (CDC).² The CDC reported 87.2 cases of maternal syphilis per 100,000 live births in 2016, vs 280.4 per 100,000 live births in 2022.

Overall, the rate of congenital syphilis during this period rose by 222%, with annual increases ranging from 15% in 2017 to 32% in 2021. Additionally, all race and Hispanic-origin groups experienced increasing rates of congenital syphilis, from 48% among Pacific Islander non-Hispanic patients to 783% among American Indian and Alaska Native non-Hispanic patients.

Additionally, mothers without prenatal care had the most significant increase of 298%. The second highest rate was among mothers with care starting in the third trimester at 244%, and the third highest of 240% among those with care starting in the second trimester.

Syphilis cases increased by 197% among mothers beginning care in the first trimester. This data further supports the notion that delays in prenatal care lead to increased rates of congenital syphilis incidence.

References

1. Gastanaduy M. Predictors of congenital syphilis from a regional health system in Louisiana. Presented at: The Infectious Disease Society for Obstetrics and Gynecology 2024 Annual Meeting. Portland, OR. August 1-3, 2024.
2. Krewson C. CDC data reveals surge in maternal syphilis rates. February 16, 2024. Accessed August 7, 2024. https://www.contemporaryobgyn.net/view/cdc-data-reveals-surge-in-maternal-syphilis-rates