Rising Stillbirth Rates Related to Congenital Syphilis in the United States From 2016 to 2022

Area of Science:

• Public Health
• Infectious Diseases
• Maternal-Fetal Medicine

Background:

• Congenital syphilis (CS) poses a significant threat to fetal well-being.
• Understanding trends and risk factors for CS-related stillbirth is crucial for public health interventions.

Purpose of the Study:

• To analyze trends in stillbirth rates associated with congenital syphilis in the United States.
• To compare characteristics of pregnant individuals experiencing stillbirth due to CS with those with liveborn neonates with CS.

Main Methods:

• Analysis of congenital syphilis cases reported to the CDC (2016-2022).
• Categorization of cases into stillbirth, preterm live birth, or term live birth.
• Comparison of demographic, clinical, and care-related factors between outcome groups.

Main Results:

• Congenital syphilis-related stillbirths increased annually from 2016-2022.
• Stillbirths accounted for 6.4% of all CS cases, with a median gestational age of 30 weeks.
• Lack of prenatal care (58.4%), high syphilis titers (≥1:32, 78.9%), and secondary syphilis stage were associated with increased stillbirth risk.

Conclusions:

• Over 1 in 20 pregnancies with CS resulted in stillbirth.
• High syphilis titers, secondary stage, and absence of prenatal care are key risk factors for stillbirth.
• Rising CS prevalence projects an increase in national stillbirth rates without intervention.