Substance Use Among Persons with Syphilis During Pregnancy - Arizona and Georgia, 2018-2021

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Maternal and Child Health

Background:

• Syphilis in pregnancy and congenital syphilis rates are rising in the US despite screening and treatment availability.
• Concurrent increases in substance use, including methamphetamine, injection drugs, and heroin, are noted among pregnant individuals with syphilis.

Purpose of the Study:

• To describe the prevalence of substance use among pregnant individuals with syphilis, comparing outcomes of congenital syphilis pregnancies to non-congenital syphilis pregnancies.
• To identify specific substances associated with adverse pregnancy outcomes related to syphilis.

Main Methods:

• Analysis of birth data from January 2018 to December 2021 from Arizona and Georgia, part of the Surveillance for Emerging Threats to Pregnant People and Infants Network (SET-NET).
• Categorization of pregnancy outcomes based on the surveillance case definition for probable or confirmed congenital syphilis.
• Comparison of substance use prevalence (tobacco, alcohol, cannabis, illicit opioids, other illicit substances) between congenital and non-congenital syphilis pregnancy groups.

Main Results:

• Substance use prevalence was 48.1% in congenital syphilis pregnancies versus 24.6% in non-congenital syphilis pregnancies.
• Individuals with congenital syphilis pregnancies were six times more likely to report illicit opioid use and four times more likely to report using other illicit, nonprescription substances.
• About half of pregnant individuals with substance use and a congenital syphilis outcome received late or no prenatal care.

Conclusions:

• Substance use is significantly associated with congenital syphilis outcomes.
• Late or absent prenatal care is common among pregnant individuals with substance use and congenital syphilis, indicating missed opportunities for intervention.
• Interventions must address barriers to syphilis screening and treatment for substance-using pregnant individuals, integrating care into all prenatal encounters.