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Abstract
Objectives To examine the temporal trend and risk factors associated with lack of prenatal care and the association between lack of prenatal care and adverse outcomes in pregnancies complicated by syphilis.
Methods We conducted a retrospective cohort study using US vital statistic data (2016–2022). We included non-anomalous, singleton live births delivered by pregnancies complicated by syphilis at 24–42 weeks of gestation in a hospital. The exposure variable was prenatal care (had care vs no care). We used Adequacy of Prenatal Care Utilization Index. Adverse outcomes were examined. The annual per cent change (APC) was calculated to assess the trend of lacking prenatal care. Multivariable Poisson regression models with robust error variance were used to examine the association. Adjusted relative risks (aRR) with 95% CIs were calculated.
Results Among the study population of 38 583 live births, 2417 (6.3%) lacked prenatal care. The rate of lacking prenatal care increased over time (APC=11.4; 95% CI 4.7 to 18.5). Maternal education, insurance, nulliparity, prepregnancy body mass index, prior preterm birth, smoking, diabetes, hepatitis C and year of delivery were associated with lacking prenatal care. Compared with individuals with prenatal care, those without care were associated with a higher risk of preterm birth <37 weeks (aRR 2.57; 95% CI 2.40 to 2.74) and <34 weeks (aRR 3.56; 95% CI 3.13 to 4.05). Compared with patients with adequate care, those without care were associated with a higher risk of preterm birth <37 weeks (aRR 5.07; 95% CI 4.59 to 5.60) and <34 weeks (aRR 6.42; 95% CI 5.32 to 7.75). Similar associations were shown in other adverse outcomes.
Conclusions Among pregnancies complicated by syphilis in the USA, there was an upward trend in lack of prenatal care from 2016 to 2022. Modifiable factors of lacking prenatal care were identified. The risks of adverse outcomes were higher among individuals without prenatal care.
- SYPHILIS
- PREGNANCY
- Prenatal Care
- OBSTETRICS
Data availability statement
Data are available in a public, open access repository. Data are available publicly in CDC website.
Statistics from Altmetric.com
Data availability statement
Data are available in a public, open access repository. Data are available publicly in CDC website.
Footnotes
Handling editor Merle Henderson
Contributors HC contributed to the conception and design of the work, performed data management and data analysis and drafted the manuscript. IS contributed to the conception and design of the work, interpretation of the data and drafted the manuscript. All authors critically revised the manuscript, and all approved the final manuscript. HC is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer-reviewed.
Author note The authors of this manuscript represent diverse self-identified gender, racial and ethnic backgrounds, all dedicated to the field of public health and the study of sexually transmitted infections. While we acknowledge the presence of unconscious bias, our first-hand experiences with patient care, research, and personal lives have made us acutely aware of the structural barriers to equitable care. We are committed to addressing these issues and driving change in this field.
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