Prenatal STD Screening Suboptimal Among Insured Women

Laurie Barclay, MD

April 08, 2015

Prenatal screening for syphilis and hepatitis B was nearly universal among Medicaid-insured and commercially insured women, but screening rates for HIV and chlamydia were much lower, according to a study published online April 3 in Obstetrics & Gynecology.

"Given that women in our study had prenatal care, health care provider-level barriers such as lack of awareness of the current guidelines or available testing methods may contribute to low [sexually transmitted disease (STD)] screening rates," write Christine E. Ross, MD, MPH&TM, from the Division of STD Prevention and the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues. "Improved adherence to national recommendations, combined with structural interventions, could reduce adverse outcomes related to STDs in pregnancy."

The authors note that untreated STDs increase the risk for adverse outcomes in pregnant women and their offspring, including spontaneous abortion, preterm labor, stillbirth, and congenital malformations. "Because of these potential adverse outcomes and the availability of low-cost, accurate diagnostic tests and highly effective treatments, prenatal screening is recommended for several sexually transmitted infections."

To estimate prenatal screening rates for syphilis, hepatitis B, HIV, chlamydia, and gonorrhea among insured women with prenatal care, the researchers analyzed data from a 2009 to 2010 US administrative claims database that includes data on both Medicaid-insured and commercially insured persons.

The investigators used procedural and diagnostic codes to identify pregnant women, aged 15 to 44 years, who had a live birth in 2010, continuous insurance coverage at least 210 days before delivery, and at least one typical prenatal blood test.

Screening rates among 98,709 Medicaid-insured pregnant women were 96.3% for syphilis, 96.3% for hepatitis B, 82.4% for HIV, 83.1% for chlamydia, and 74.8% for gonorrhea. Screening rates among 266,012 commercially insured women were 97.8%, 96.8%, 85.4%, 70.3%, and 68.6%, respectively.

Among both these groups, women who had a Pap test were more likely to have prenatal screening for chlamydia and gonorrhea (P < .001 by χ2 test). Younger women and non-Hispanic black women had the highest chlamydia screening rates.

"Despite near universal screening for syphilis and hepatitis B among women in our study, prenatal screening for HIV was suboptimal," the authors write. "Chlamydia screening was also underutilized and was more likely to occur in the setting of a Pap test. Our analysis was restricted to women with prenatal care and receipt of typical obstetric blood testing, suggesting that many women who missed prenatal STD and HIV screening likely had opportunity to receive these services."

The authors note several study limitations, including lack of generalizability because of the use of a convenience sample.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. Published online April 3, 2015. Abstract


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