Early Third-Trimester Syphilis Screening Adherence Among Medicaid Recipients in New York City, 2020-2022

In November 2019, New York City (NYC) mandated universal syphilis screening during pregnancy at 28 to 32 weeks' gestation (early third-trimester syphilis screening [ETTSS]) for congenital syphilis prevention. Medicaid is a significant payer for pregnancy-related and sexually transmitted infection care in NYC. We examined adherence to, and disparities in, ETTSS among pregnancies of NYC Medicaid recipients from 2020 to 2022.

We used Medicaid claims data to identify pregnancies using International Classification of Diseases, Tenth Revision codes related to delivery outcome and gestational age. We included people at least 12 years old with birth events at ≥33 weeks' gestation, and enrollment in Medicaid for the entire pregnancy. We identified syphilis screening using Current Procedural Terminology codes and enumerated screening timelines. Using log-binomial regression, we calculated adjusted prevalence ratios (aPR) for ETTSS by race/ethnicity, birth outcome, county of residence, and neighborhood poverty level.

Of 105,092 pregnancies, 29.7% (31,193 of 105,092) received ETTSS. The proportion of pregnancies that received ETTSS increased from 29.4% (8925 of 30,396) in 2020 to 30.0% (11,656 of 38,859) in 2022 ( P = 0.03). Compared with Hispanic persons, ETTSS was lower in Non-Hispanic (NH) Asian/Pacific Islander (aPR, 0.89; confidence interval [CI], 0.86-0.92), NH-Black (aPR, 0.90; CI, 0.88-0.93), NH-White (aPR, 0.76; CI, 0.74-0.79), and NH-Other race (aPR, 0.80; CI, 0.77-0.83) groups. Early third-trimester syphilis screening was higher among pregnant people living in high/very-high-poverty neighborhoods compared with those in low/medium-poverty neighborhoods (aPR, 1.15; CI, 1.13-1.17).

Early third-trimester syphilis screening was performed in less than one-third of pregnancies, with differential screening levels by key sociodemographics. Monitoring ETTSS adherence over time is important to inform congenital syphilis prevention interventions.