Maternal Health Outcomes Associated With Syphilis Infection During Pregnancy: Evidence From a Large US All-Payer Hospital-Centered Administrative Database
Abstract
Abstract Background Syphilis during pregnancy is associated with preventable maternal and infant harms. As syphilis rates rise in the United States, recent, nationally representative data on maternal outcomes remain limited. Methods A retrospective cohort study was conducted using a large all-payer administrative database to assess the prevalence of maternal syphilis, variation in screening, testing, treatment, and associations with maternal outcomes and healthcare utilization. The study included inpatient delivery hospitalizations at 20 or more weeks of gestation discharged 1 October 2019, to 31 December 2023, with 365-day look-back and 90-day follow-up periods. The cohort comprised 3 639 838 deliveries, including 5533 documented with maternal syphilis. Outcomes included hypertensive disorders of pregnancy, severe maternal morbidity (SMM), length of stay, hospital costs, and hospital returns. Results Syphilis prevalence was 152 per 100 000 deliveries with escalation throughout the study period. Rates were higher among younger, American Indian/Alaska Native and Black, and Medicaid-covered patients. Documented nontreponemal screening and treponemal testing were observed for 29% and 30% of deliveries, respectively. Among deliveries with syphilis, 22% had documented administration of penicillin. After adjustment for maternal and hospital characteristics, syphilis was associated with higher adjusted odds ratio (aOR) of hypertensive disorders (aOR 1.18), 90-day returns (aOR 1.39), SMM including transfusion (aOR 1.23), longer delivery stays (adjusted rate ratio1.09), and higher in-hospital costs (adjusted cost ratio 1.08). Conclusions Maternal syphilis prevalence increased and was associated with greater maternal morbidity, resource utilization, and costs. Variation in documented screening, testing, and treatment frequencies highlights potential opportunities to improve implementation of recommended care.