(P7) CONTRIBUTION OF INEQUALITIES IN ACCESS AND QUALITY OF PRENATAL CARE TO CONGENITAL SYPHILIS BURDEN

Background:
Inequalities in access and quality of prenatal care contribute to adverse maternal and child outcomes. We evaluated the impact of current versus improved prenatal care in preventing congenital syphilis and reducing racial and ethnic disparities.

Methods:
We used a compartmental cohort model to simulate syphilis natural history, prenatal care, and syphilis screening in Medicaid-insured pregnant persons. People were stratified by race/ethnicity (Hispanic, Non-Hispanic[NH]-White, NH-Black, NH-American Indian/Alaska Native[NH-AI/AN], NH-Native Hawaiian or Pacific Islander[NH-NHOPI], NH-Asian, NH-Multiracial). Prenatal care quality was assessed using ‘adequacy of prenatal care utilization' (APNCU) index, categorized as no prenatal care, inadequate care, intermediate care, adequate and adequate+ care. The ‘current care’ scenario was parameterized by race/ethnicity using data from birth certificates indicating potential syphilis diagnosis during pregnancy and APNCU category, and Medicaid claims data on screening coverage. In the counterfactual ‘adequate care’ scenario, all pregnant persons received care beginning no later than the 4th month of pregnancy, and underwent syphilis screening at least once.

Results:
In 2019, syphilis positivity among Medicaid insured pregnant individuals in birth certificate data were 6 times as high as among privately insured individuals (0.3% vs 0.05%). Among Medicaid-insured pregnant persons, 2.6% received no prenatal care and 19.1% received inadequate care. Compared to the NH-White population, other populations were more likely to have no prenatal care or inadequate prenatal care, with highest proportions of inadequate care occurring among NH-AI/AN persons (29% received inadequate care) and NH-NHOPI persons (43%). Compared to current care, we estimated that two-thirds of congenital syphilis cases could be averted if people received adequate prenatal care. Adequate care was estimated to reduce congenital syphilis by 72% (95% range 59-97%) in the NH-Black and 65% (62-95%) in the NH-White population. Results were sensitive to estimated syphilis incidence.

Conclusion:
Improving equitable access to quality prenatal care could produce substantial reductions in congenital syphilis burden.