Gaps in syphilis screening among pregnant women in North Carolina

Background: Congenital syphilis rates have risen nationally and in North Carolina (NC). We assessed syphilis screening among pregnant women in NC. Methods: A retrospective chart review was conducted among patients with a pregnancy episode—created at first prenatal care encounter or labor/delivery—at a NC health system from 1/1/2019-12/31/2023. 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 binominal regression with generalized estimating equations to explore associations between clinical and sociodemographic factors and syphilis screening. Results: 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 28-31 weeks, and 22.0% had all required syphilis screening. Completion of required syphilis screening was more common among women aged 18-24 compared to ≥35 years (PR 1.15; CI: 1.10-1.21), and those who were uninsured compared to privately insured (PR 1.33; CI: 1.27-1.39), but less common among Black/African American women compared to White women (PR 0.93; CI: 0.89-0.96), those who preferred non-English languages for healthcare communication compared to English (PR 0.85; CI 0.81-0.90), and who initiated care in an emergency department compared to a women’s health clinic (PR 0.13; 95% CI: 0.12-0.15). Conclusions: Completion of all required syphilis screening was low among pregnant women, highlighting a major gap in congenital syphilis prevention.