Medical practices for prevention of perinatal infections in Puerto Rico

Area of Science:

• Maternal and Child Health
• Infectious Disease Prevention
• Public Health Surveillance

Background:

• Established recommendations for maternal infection screening and fetal/newborn disease prevention in Puerto Rico for over a decade.
• Limited documentation exists regarding compliance with these critical public health guidelines.
• This study addresses the need to evaluate current practices and identify areas for improvement.

Purpose of the Study:

• To evaluate compliance with rubella and hepatitis B prenatal screening and vaccination recommendations.
• To assess hospital screening practices for syphilis and human immunodeficiency virus (HIV).
• To identify risk factors associated with suboptimal prenatal care.

Main Methods:

• Review of medical records from a random, stratified sample of 2003 pregnant women delivering in eight Puerto Rican maternity hospitals in 2002.
• Inclusion of obstetric prenatal and postnatal records to document screening and vaccination status.
• Analysis of screening documentation for rubella, hepatitis B surface antigen (HBsAg), HIV, and syphilis.

Main Results:

• High prenatal screening rates: 98.4% for rubella and 98.8% for HBsAg.
• 5.4% of women remained susceptible to rubella; no eligible women received postpartum rubella vaccination.
• Low rates of hepatitis B vaccination for newborns born to mothers with unknown HBsAg status (0.9%).
• Screening documentation was high for HIV (85.7%) and syphilis (87.9%).
• Suboptimal prenatal care was linked to teenage mothers, lower education levels, and multiparity (>3 pregnancies).

Conclusions:

• While prenatal screening for rubella and hepatitis B is high, implementation of preventive interventions needs enhancement.
• Significant gaps exist in postpartum rubella vaccination and timely hepatitis B vaccination for at-risk newborns.
• Addressing socioeconomic factors is crucial for improving overall prenatal care quality.