Integrating law, coverage, and maternal–fetal medicine workflows to eliminate congenital syphilis: A systematic review and policy synthesis

Congenital syphilis (CS) persists as a preventable cause of stillbirth and neonatal morbidity despite the availability of simple screening and curative treatment. Fragmented legal mandates, inconsistent payer coverage, and variable maternal–fetal medicine (MFM) workflows contribute to preventable transmission. This systematic review and policy synthesis integrates global evidence to define a modern framework for eliminating CS through coordinated action across law, financing, and clinical care. Comprehensive searches of biomedical databases, guidelines, and policy registers identified 2292 records; 27 studies met the inclusion criteria following Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 standards. Sources included systematic reviews, national guidelines, modeling studies, and legal documents. Data were extracted on screening schedules, treatment regimens, coverage mechanisms, and workflow integration. Quality was assessed using A Measurement Tool to Assess Systematic Reviews, version 2, Risk of Bias in Systematic Reviews, and Newcastle–Ottawa tools. Across studies, universal early testing, third-trimester and delivery rescreening, and benzathine penicillin access were consistently associated with improved outcomes. National mandates and payer reimbursement policies increased screening compliance, while electronic health record alerts and point-of-care testing shortened treatment delays. However, persistent inequities affected low-resource and minority population. Synthesized findings support a “triple-lock” model – binding legal mandates, guaranteed financial coverage, and digital workflow automation – as the pathway to sustainable elimination. The review calls for harmonized laws, procurement transparency, and integrated partner management within antenatal care. Although not registered in PROSPERO due to its cross-disciplinary scope, this review provides the most comprehensive evidence-policy bridge to date for the global eradication of CS.