Gaps in Syphilis Screening Among Pregnant Women in North Carolina

Congenital syphilis rates have risen nationally and in North Carolina (NC). We assessed syphilis screening among pregnant women in NC.

A retrospective chart review was conducted among patients with a pregnancy episode-created at first prenatal care encounter or labor/delivery-at an NC health system from January 1, 2019 to December 31, 2023. We estimated the proportion with syphilis screening at timepoints required by NC law (before 28 weeks of gestation, 28-31 weeks of gestation, and within 1 week of delivery) using syphilis test dates and delivery dates. We estimated prevalence ratios (PR) and 95% confidence intervals (CIs) using log binomial regression with generalized estimating equations to explore associations between clinical and sociodemographic factors and syphilis screening.

We identified 64,803 pregnancies among 54,446 patients. Syphilis screening was conducted at least once in 99.5% of pregnancies. Only 27.6% had syphilis screening recorded at 28 to 31 weeks, and 22.0% had all required syphilis screening. Completion of required syphilis screening was more common among women aged 18 to 24 compared with ≥35 years (PR, 1.15; CI, 1.10-1.21), and those who were uninsured compared with privately insured (PR, 1.33; CI, 1.27-1.39), but less common among Black/African American women compared with White women (PR, 0.93; CI, 0.89-0.96), those who preferred non-English languages for healthcare communication compared with English (PR, 0.85; CI, 0.81-0.90), and who initiated care in an emergency department compared with a women's health clinic (PR, 0.13; 95% CI, 0.12-0.15).

Completion of all required syphilis screening was low among pregnant women, highlighting a major gap in congenital syphilis prevention.