Late Prenatal Care Research Articles

Unique Pattern of Missed Opportunities for Congenital Syphilis Prevention in Alabama Compared to National Trends

Abstract Background Missed opportunities to prevent congenital syphilis include no syphilis testing during prenatal care, late prenatal care, inadequate treatment, no prenatal care, late identification, and unidentified missed opportunities. Cases of unidentified missed opportunities are those identified as newborns with congenital syphilis born to mothers that received adequate treatment thirty days before delivery. Missed opportunities in Alabama may differ from national trends. Comparing rates of missed opportunities in Alabama to national trends may help inform Alabama physicians of the most effective intervention points for our state. Methods Data on congenital syphilis cases and rates of missed opportunities from 2018-2021 were collected from the Alabama Department of Public Health and CDC STI datasets. The occurrence of missed opportunity types in Alabama was determined and compared to national trends. Results No timely prenatal care or syphilis testing was the greatest missed opportunity nationally at 37.58%. However, the most prevalent missed opportunity in Alabama was late identification of seroconversion at 44.44% in comparison to 14.22% nationally. Second most common missed opportunity in Alabama was no timely prenatal care or syphilis testing (divided into no prenatal care at 14.81% and late prenatal care at 6.17%). Additionally, evidence of congenital syphilis despite maternal treatment was the least common missed opportunity nationally (3.75%) but made up 25% of missed opportunities in Alabama in 2021. Conclusion The incidence of late identification of seroconversion in Alabama is three times the national average, which emphasizes the need for targeted interventions to address this disparity. Furthermore, congenital syphilis despite maternal treatment in Alabama is six times the national rate, suggesting a need for further investigation into other missed opportunities.

Adverse Childhood Experiences, Interpersonal Violence, and Racial Disparities in Early Prenatal Care in North Dakota (ND PRAMS 2017-2019).

In North Dakota (ND), American Indian women are more likely to be exposed to adverse childhood experiences (ACEs) and interpersonal violence, and receive late prenatal care (PNC) compared to other racial groups. In a sample of 1,849 (weighted n = 26,348) women from the 2017 to 2019 North Dakota Pregnancy Risk Assessment Monitoring System, we performed a series of logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for AI and Other Racial Identity women compared to White women regarding risk of late PNC (initiated after week 13) and dissatisfaction of PNC timing. Models were adjusted for interpersonal violence (from husband/partner, family member, someone outside of family, ex-husband/partner, or any) to determine if violence accounts for racial/ethnic disparities in PNC. AI women experienced two-fold higher risk of late PNC (OR: 2.25, 95% CI: 1.55, 3.26) and dissatisfaction of PNC timing (OR: 2.34, 95% CI: 1.61, 3.40) than White women. In the analyses for the association between joint ACEs (Higher: ≥4; Lower: <4)/Race and PNC outcomes, odds of late PNC were two-fold among AI women with Higher ACEs (OR: 2.35, 95% CI: 1.41, 3.94) and Lower ACEs (OR: 2.73, 95% CI: 1.69, 4.41), compared to White women with Lower ACEs. Results were similar for dissatisfaction of PNC timing. Accounting for violence did not significantly change odds ratios in any analyses. Thus, interpersonal violence surrounding pregnancy does not explain racial disparities in PNC in ND. To understand disparities in PNC among AI women, risk factors like historic trauma and systemic oppression should be examined.

A Descriptive Study on the Prevalence of Anemia and Its Associated Sociodemographic Factors among Pregnant Females Attending Primary Health Center in Hisar District, Haryana

Context: Anemia is one of the major public health issues in the world. India carries the highest burden of disease, especially in pregnant and lactating mothers. The predisposing factors include grand multiparity, low socioeconomic status, living conditions, diet, maternal infection, late prenatal care affecting the maternal and neonatal health. It has detrimental effects on maternal and child health. Aim and Objective: To estimate the prevalence of anemia among pregnant females attending the Primary Health Centre, Agroha and to determine sociodemographic risk factors associated with anemia in pregnancy. Settings and Design: This cross-sectional study was conducted among 270 pregnant females of rural background visiting Primary Health Center of District Hisar. Materials and Methods: All the data comprising of sociodemographic profile was gathered using a predesigned and pretested pro forma. Socioeconomic status was evaluated using the Modified B.G. Prasad Scale. Hemoglobin estimation was done using Sahli’s acid hematin method. The cutoff for Hb level was taken from standard guidelines. Statistical Analysis Used: Data were first entered in Microsoft Excel 10 and then was further exported to the PASW Statistics for Windows version 18.0 (SPSS Inc., Chicago). Association between two or more variables was determined by the Chi-square test and Fisher’s test. Degree of relationship among variables was determined by correlation coefficient. Results: The overall prevalence of anemia came out to be 70% among pregnant females, out of which 37.4% were mild anemic followed by 31.9% as moderate and 0.7 as severe anemic. Conclusions: This study showed that although preventable, anemia is still prevalent in our society it remains a major risk factor for increased morbidity and mortality.

Late Prenatal Care as a Risk Factor for Preeclampsia [ID: 1377685

INTRODUCTION: Hypertensive disorders of pregnancy including preeclampsia account for 16% of maternal deaths in high-income countries. The American College of Obstetricians and Gynecologists lists a number of known risk factors for preeclampsia in its Practice Bulletin No. 222, “Gestational Hypertension and Preeclampsia.” The objective of this study was to identify whether late prenatal care, not a documented risk factor, is associated with an increased risk of preeclampsia. METHODS: A secondary analysis was performed on a dataset from an IRB-approved research study looking at chronic hypertension and contraception after pregnancy. As chronic hypertension is associated with preeclampsia and can be diagnosed in pregnancy by elevated blood pressures before 20 weeks of gestation, the dataset allowed comparison of patients who presented to care before 20 weeks versus after 20 weeks. Data were analyzed using descriptive statistics, chi-square, Student t test, and multivariate logistic regression. RESULTS: A total of 2,147 patients were included. 1,826 patients had early prenatal care (before 20 weeks) and 321 patients had late prenatal care (after 20 weeks). 8.5% of patients with early prenatal care had preeclampsia, compared to 12.1% of patients with late prenatal care (odds ratio 1.49, P=.0359, 95% CI 1.0266–2.1652). After multivariate logistic regression modeling, late prenatal care was a risk factor significantly associated with preeclampsia in African American patients (P=.030). CONCLUSION: Patients presenting for prenatal care in the second half of pregnancy are at increased risk of developing preeclampsia. Anticipatory guidance and education should be targeted for these patients.

Increased Risk of Preterm Birth in a Native American Population Concurrent With the COVID-19 Pandemic [ID: 1377321

INTRODUCTION: The objective of this study was to evaluate changes in obstetric outcomes in a Native American population compared with other racial groups. METHODS: An electronic birth certificate based system was used to obtain data for all singleton births in the Central New York region from January 2012 to June 2022 after IRB exemption. Race was self-identified and categorized as White, Black, Native American, or other. We compared delivery before or after January 2020. The primary outcome was premature birth. Secondary outcomes included prenatal care adequacy, fetal growth restriction, neonatal outcome, diabetes, hypertension, and obesity. Analysis was preformed using χ2 and logistic regression including body mass index (BMI), smoking, hypertension, and diabetes. RESULTS: Out of 178,420 singleton births, 2,647 (1.4%) identified as Native American, 143,743 (77.7%) as White, and 15,476 (8.4%) as Black. Compared to patients before 2020, no racial group had a higher rate of inadequate or late prenatal care, and all groups had increased obesity (BMI &gt;30) and decreased smoking. Preterm birth increased in the Native American population before 37, 34, and 28 weeks of gestation: adjusted odds ratio (95% CI) 1.42 (1.02–1.99), 1.81 (1.02–3.22), and 3.68 (1.39–9.77). No other population had increased preterm birth before 34 or 28 weeks of gestation. CONCLUSION: There was a significant increase in all categories of preterm birth in the Native American population during the COVID-19 pandemic without a differential increase in known risk factors compared to other racial groups. This highlights the need for more research on the causes of adverse outcomes in Native American populations.

Exploring Patients' Needs and Desires for Quality Prenatal Care in Florida, United States.

High-quality prenatal care promotes adequate care throughout pregnancy by increasing patients' desires to return for follow-up visits. Almost 15% of women in the United States receive inadequate prenatal care, with 6% receiving late or no prenatal care. Only 63% of pregnant women in Florida receive adequate prenatal care, and little is known about their perceptions of high-quality prenatal care. Therefore, the objective of this study was to assess women's perceptions of the quality of their prenatal care and to describe their preferences for seeking prenatal care that meets their needs. From April to December 2019, a qualitative study was conducted with postpartum women (n = 55) who received no or late prenatal care and delivered in Tampa, Florida, USA. Eligible women completed an open-ended qualitative survey and a semi-structured in-depth interview. The interview contextualized the factors influencing prenatal care quality perceptions. The qualitative data analysis was based on Donabedian's quality of care model. The qualitative data analysis revealed three key themes about women's perceptions and preferences for prenatal care that meets their needs. First, clinical care processes included provision of health education and medical assessments. Second, structural conditions included language preferences, clinic availability, and the presence of ancillary staff. Finally, interpersonal communication encompassed interactions with providers and continuity of care. Overall, participants desired patient-centered care and care that was informative, tailored to their needs, and worked within the constraints of their daily lives. Women seeking and receiving prenatal care prefer a welcoming, patient-centered health care environment. These findings should prompt health care providers and organizations to improve existing prenatal care models and develop new prenatal care models that provide early, accessible, and high-quality prenatal care to a diverse population of maternity patients.

Changes in prenatal care and birth outcomes after federally qualified health center expansion.

To evaluate whether the expansion of Federally Qualified Health Centers (FQHCs) improved late prenatal care initiation, low birth weight, and preterm birth among Medicaid-covered or uninsured individuals. We identified all FQHCs in California using the Health Resources and Services Administration's Uniform Data System from 2000 to 2019. We used data from the U.S. Census American Community Survey to describe area characteristics. We measured outcomes in California birth certificate data from 2007 to 2019. We compared areas that received their first FQHC between 2011 and 2016 to areas that received it later or that had never had an FQHC. Specifically, we used a synthetic control with a staggered adoption approach to calculate non-parametric estimates of the average treatment effects on the treated areas. The key outcome variables were the rate of Medicaid or uninsured births with late prenatal care initiation (>3months' gestation), with low birth weight (<2500 grams), or with preterm birth (<37 weeks' gestation). The analysis was limited to births covered by Medicaid or that were uninsured, as indicated on the birth certificate. The 55 areas in California that received their first FQHC in 2011-2016 were more populous; their residents were more likely to be covered by Medicaid, to be low-income, or to be Hispanic than residents of the 48 areas that did not have an FQHC by the end of the study period. We found no statistically significant impact of the first FQHC on rates of late prenatal care initiation (ATT: -10.4 [95% CI -38.1, 15.0]), low birth weight (ATT: 0.2 [95% CI -7.1, 5.4]), or preterm birth (ATT: -7.0 [95% CI -15.5, 2.3]). Our results from California suggest that access to primary and prenatal care may not be enough to improve these outcomes. Future work should evaluate the impact of ongoing initiatives to increase access to maternal health care at FQHCs through targeted workforce investments.

Combining immigration records with a postpartum population-based survey to assess prevalence of perinatal psychosocial and behavioral risk factors among immigrant subgroups.

ObjectivesPerinatal risk factors can vary by immigration status. To advance knowledge on sociobehavioral health risks among pregnant and childbearing immigrant women, we compared perinatal health indicators between immigrant and non-immigrants, overall, and according to key immigrant characteristics (refugee status, secondary migration, birth region, and duration of residence). ApproachWe conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women in Manitoba, Canada, aged 15-55 years, who had newborn screening data completed by public health nurses within two weeks postpartum from 2000 to 2017. The screening data was linked to a Canadian national immigration database. Additional databases were linked to collect demographic and perinatal clinical information. Logistic regression models were used to examine the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use and late prenatal care initiation. ResultsMore immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.90, 95% Confidence Interval (CI): 6.53, 7.28) but exhibited lower odds of other outcomes. In the analysis restricted to immigrants, recent immigrants (&lt; 5 years of stay) had higher odds of being socially isolated (aOR: 9.29, 95% CI: 7.80, 11.06) and late prenatal care (aOR: 1.73, 95% CI: 1.23, 2.42) compared to long-term immigrants, but lower odds relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with social isolation, relationship distress, depression, and late prenatal care whereas secondary migration was protective for social isolation, relationship distress, and smoking. Relationship distress and behavioral health indicators varied by maternal birth region. ConclusionThe novel linkage of birth screening data with the immigration data advances knowledge on immigrant perinatal health by identifying risk patterns for multiple psychosocial and behavioral health indicators, highlighting subgroups at higher and lower risk of exposures that may contribute to adverse perinatal health outcomes.

The perinatal epidemiology of child and adolescent marriage in Brazil, 2011–2018

Brazil is one of the top contributors of girl child marriages in the world and one of the United Nations’ members that committed to end child marriage by 2030 as part of the Sustainable Development Goals. Child marriage is an indicator of gender inequality associated with poor health outcomes. However, the perinatal epidemiology of minor mothers (<18 years) according to marital status has been insufficiently studied. We used 23,163,209 birth registrations (2011–2018) to describe the sociodemographic distribution of births to minor mothers. The association between adverse outcomes and marital status and maternal age was restricted to 7,953,739 births of mothers aged ≤15, 16–17, 18–19, 20–24 years. Multinomial logistic models were used for very (24–31 weeks) and moderately preterm birth (32–36 weeks), and severe (<3rd percentile) and moderately small-for-gestational age (SGA) (3rd to <10th percentile). Logistic models were used for binary outcomes. The proportion of births to minor mothers in the study period was 8.9%, composed of those of single (6.1%), common-law (2.4%) and married girls (0.4%). Births to minor mothers decreased over time (p-value <0.001), were more common in the North Region (13.2%) and among Indigenous (17.4%). Very and moderately preterm birth increased with decreasing age but within each age group, rates were highest among single, followed by common-law and lowest among married mothers. A similar pattern was observed for SGA, low Apgar and late prenatal care initiation. Repeat birth and low age-appropriate education were less common among married compared to single mothers in all age groups, except among ≤15-year-olds [Adjusted Odds Ratio (AOR): 2.56; 95% Confidence Interval (95%CI): 2.40, 2.74 and AOR: 1.30; 95%CI: 1.03, 1.64, respectively]. The association between perinatal indicators and marital status among adolescents is strongly modified by decreasing maternal age. Marital status is relevant for the understanding of early pregnancies.

Characteristics of Pregnant Women With Syphilis and Factors Associated With Congenital Syphilis at a Chicago Hospital.

BackgroundCongenital syphilis incidence has more than tripled in recent years, in parallel with the resurgence of syphilis among reproductive-aged women. An understanding of risk factors associated with maternal syphilis infection can guide prevention of congenital syphilis through prenatal diagnosis and treatment. We aimed to describe factors associated with maternal syphilis and congenital syphilis at a public medical center in Chicago, Illinois.MethodsMaternal syphilis diagnoses were identified using a database for local health department reporting. Medical records were reviewed for infant congenital syphilis diagnoses, sociodemographic information, medical history, and other behavioral factors. Maternal characteristics associated with congenital syphilis were assessed using logistic regression.ResultsOf 106 maternal syphilis diagnoses between 2014 and 2018, 76 (72%) had a known pregnancy outcome; of these, 8 (11%) delivered an infant with congenital syphilis. Women with psychiatric illness and noninjection substance use each had a >5-fold increased odds of having an infant with congenital syphilis. Cases with congenital syphilis were more likely to have late or scant prenatal care and initiated treatment nearly 3 months later in pregnancy. None were human immunodeficiency virus positive or reported incarceration, intravenous substance use, sex work, or having sex with men who have sex with men.ConclusionsMaternal psychiatric illness and substance use may have complicated prenatal care and delayed syphilis treatment, describing a population in need of public health intervention. Women experiencing such barriers to care may benefit from closer follow-up after a prenatal syphilis diagnosis to prevent congenital transmission.

Congenital syphilis prevention in the context of methamphetamine use and homelessness.

Congenital syphilis (CS) is increasing in the United States and is associated with intersecting social and structural determinants of health. This study aimed to delineate birthing parent characteristics associated with CS in an adjusted model. METHODS (N = 720): People diagnosed with syphilis during pregnancy from 2017 to 2018 who were interviewed and linked to infants in the California state surveillance system were included (herein, "birthing parents"). Sociodemographic and clinical CS risk factors informed a stepwise multivariable logistic regression model in which the outcome of interest was infants born with CS. CS prevention continuums delineated the proportion of pregnant people with syphilis who completed steps (e.g., prenatal care entry, syphilis testing, treatment) needed to prevent CS; the outcome was delivering an infant without CS. We stratified continuums by homelessness and methamphetamine use to explore differences in CS outcomes. Of 720 birthing parents, 245 (34%) delivered an infant with CS. Although CS was initially associated with homelessness (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.6, 4.0) and methamphetamine use (OR = 2.1, 95% CI: 1.4, 3.1), the addition of prenatal care into a final adjusted model attenuated these associations to not significant. In CS prevention continuums, delivering an infant without CS was less likely for people who reported methamphetamine use (p < .001) and/or homelessness (p < .001). However, when examining only those who received prenatal care, statistical differences for these predictors no longer existed. In the final adjusted model the following were associated with CS: no prenatal care (OR = 16.7, 95% CI: 9.2, 30.3) or late prenatal care (OR = 2.9, 95% CI: 1.9, 4.2); early stage of syphilis (OR = 2.6, 95% CI: 1.8, 3.7); living in Central California (OR = 2.1, 95% CI: 1.1, 4.2). This is the first analysis to explore birthing parent characteristics associated with delivering an infant with CS in an adjusted model. We demonstrate that prenatal care, when accessed, can result in effective CS prevention among people who are unhoused and/or using methamphetamine equally well compared to counterparts without these risk factors.

Disparities in early prenatal care and barriers to access among American Indian and white women in North Dakota.

American Indians/Alaska Natives (AI/AN) have received minimal attention in research on determinants of prenatal care access. We sought to gain an understanding of structural and sociocultural determinants of prenatal care access among AI/AN and White women in North Dakota (ND). Data were drawn from the 2017 to 2018 North Dakota Pregnancy Risk Assessment Monitoring System (n = 1,166). Late prenatal care was assessed with 2 variables: late prenatal care initiation (>13 weeks gestation) and "Did you get prenatal care as early in your pregnancy as you wanted?" (yes/no). Those not satisfied with timing of prenatal care initiation reported 12 prenatal care barriers (yes/no). Logistic regression estimated odds ratios and 95% confidence internals for late prenatal care among AI/AN and other race/ethnicity women compared to White women. Models included maternal sociodemographic, medical, and behavior factors. Chi-square was used to examine the prevalence of prenatal care barriers by race/ethnicity. AI/AN women had increased risk of late prenatal care initiation (OR: 1.93, 95%CI: 1.20, 3.09) and were more dissatisfied with timing of prenatal care initiation (OR: 1.73, 95% CI: 1.07, 2.78) compared to White women. AI/AN women reported higher prevalence for 8 of 12 (66%) barriers to care, including lack of transportation. Lack of health insurance was more prevalent among White women than AI/AN women (45%-8.5%; P<.01). Socioeconomic barriers to prenatal care are more prevalent among AI/AN women. This may be a consequence of systematic separation of AI/AN populations from health care resources. Alternative prenatal care delivery methods and expansion of health insurance may improve prenatal care access in ND.

Os desafios do profissional enfermeiro no pré-natal de adolescentes grávidas: uma revisão integrativa

Adolescence is the stage of life that requires a differentiated attention, because it is in this phase that physiological transformations, personality formation, adaptations and the beginning of adult life take place. The objective of this survey was to know through the current literature what the challenges of the nurse in the prenatal care of pregnant adolescentes are. It is an integrative bibliographic review, made in the LILACS (Scientific and Technical Literature of Latin America and the Caribbean); SciELO (Scientific Electronic Library Online); and Virtual Health Library (VHL); including works in Portuguese, available in the research bases from 2014 to 2020 and the sample totaled 11 articles. It was observed that adolescents, because they are not prepared for motherhood, have difficulties in accepting pregnancy, absence of Family support also interferes in the assistance offered by the nurse, they are more inclined to start late prenatal care and their capture is more difficult for health professionals. Prenatal care has been improved over the years, but there are still several factors that make care more difficult. The role of the nurse is Paramount in prenatal care, since he is the professional who best establishes the bond with pregnant women. Thus we conclude that they must be prepared for situations that demand greater performance from them, especially from this public that rarely attends UBS.

Racial Disparities in Stillbirth Risk Factors among non-Hispanic Black Women and non-Hispanic White Women in the United States.

Historically, stillbirth risk factors are more prevalent among non-Hispanic Black women than non-Hispanic White women, including age < 20, lower formal educational attainment, prepregnancy obesity, smoking, hypertension, diabetes, short interpregnancy interval, small for gestational age newborn, late prenatal care, and previous cesarean birth. We examined whether these disparities have changed since 2011 and identified a group of risk factors that differed between Black women and White women when accounting for correlations among variables. In a random sample of 315 stillbirths from the National Center for Health Statistics' 2016 fetal death data, Black women and White women were compared for each risk factor using t-tests or chi-square tests. Variables with p ≤ .20 were analyzed using multivariate analysis of variance. In this sample, Black women experiencing stillbirth were less likely to have a Bachelor's degree (12.94% vs. 28.49%, p = .04), and more likely to be obese (44.5% vs. 29.1%, p = .01) than White women. Multivariate analysis accounting for correlations among variables showed a group of risk factors that differed between Black women and White women: age < 20, lower education, prepregnancy obesity, hypertension (chronic and pregnancy-associated), nulliparity before stillbirth, and earlier gestation. Less formal education, obesity, age <20, hypertension, chronic and pregnancy-associated, nulliparity, and earlier gestation are important to consider in multilevel stillbirth prevention interventions to decrease racial disparity in stillbirth. Respectfully listening to women and taking their concerns seriously is one way nurses and other health care providers can promote equity in health outcomes for childbearing women.

Bias in Self-reported Prepregnancy Weight Across Maternal and Clinical Characteristics.

Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are known determinants of maternal and child health; calculating both requires an accurate measure of prepregnancy weight. We compared self-reported prepregnancy weight to measured weights to assess reporting bias by maternal and clinical characteristics. We conducted a retrospective cohort study among pregnant women using electronic health records (EHR) data from Kaiser Permanente Northwest, a non-profit integrated health care system in Oregon and southwest Washington State. We identified women age ≥ 18years who were pregnant between 2000 and 2010 with self-reported prepregnancy weight, ≥ 2 measured weights between ≤ 365-days-prior-to and ≤ 42-days-after conception, and measured height in their EHR. We compared absolute and relative difference between self-reported weight and two "gold-standards": (1) weight measured closest to conception, and (2) usual weight (mean of weights measured 6-months-prior-to and ≤ 42-days-after conception). Generalized-estimating equations were used to assess predictors of misreport controlling for covariates, which were obtained from the EHR or linkage to birth certificate. Among the 16,227 included pregnancies, close agreement (± 1kg or ≤ 2%) between self-reported and closest-measured weight was 44% and 59%, respectively. Overall, self-reported weight averaged 1.3kg (SD 3.8) less than measured weight. Underreporting was higher among women with elevated BMI category, late prenatal care entry, and pregnancy outcome other than live/stillbirth (p < .05). Using self-reported weight, BMI was correctly classified for 91% of pregnancies, but ranged from 70 to 98% among those with underweight or obesity, respectively. Results were similar using usual weight as gold standard. CONCLUSIONSFOR PRACTICE: Accurate measure of prepregnancy weight is essential for clinical guidance and surveillance efforts that monitor maternal health and evaluate public-health programs. Identification of characteristics associated with misreport of self-reported weight can inform understanding of bias when assessing the influence of prepregnancy BMI or GWG on health outcomes.

Profile of Chronic Comorbid Conditions and Obstetrical Complications Among Pregnant Women With Human Immunodeficiency Virus and Receiving Antiretroviral Therapy in the United States.

To evaluate the frequency and associated characteristics of chronic comorbid conditions and obstetrical complications among pregnant women with human immunodeficiency virus (HIV) and receiving antiretroviral therapy (ART) in comparison to those without HIV. We compared 2 independent concurrent US pregnancy cohorts: (1) with HIV (International Maternal Pediatric Adolescent AIDS Clinical Trials Protocol P1025, 2002-2013) and (2) without HIV (Consortium for Safe Labor Study, 2002-2007). Outcomes were ≥2 chronic comorbid conditions and obstetrical complications. For women with HIV, we assessed whether late prenatal care (≥14 weeks), starting ART in an earlier era (2002-2008), and a detectable viral load at delivery (≥400 copies/mL) were associated with study outcomes. We assessed 2868 deliveries (n = 2574 women) with HIV and receiving ART and 211 910 deliveries (n = 193 170 women) without HIV. Women with HIV were more likely to have ≥2 chronic comorbid conditions versus those without HIV (10 vs 3%; adjusted OR [AOR]: 2.96; 95% CI: 2.58-3.41). Women with HIV were slightly less likely to have obstetrical complications versus those without HIV (both 17%; AOR: .84; 95% CI: .75-.94), but secondarily, higher odds of preterm birth <37 weeks. Late entry to prenatal care and starting ART in an earlier era were associated with a lower likelihood of ≥2 chronic comorbidities and obstetrical complications; detectable viral load at delivery was associated with a higher likelihood of obstetric complications. Pregnant women with HIV receiving ART have more chronic comorbid conditions, but not necessarily obstetrical complications, than their peers without HIV.

308 Significant racial/ethnic and sociodemographic disparities in syphilis among US pregnant women

In recent years, there has been an increase in the prevalence of syphilis among pregnant women in the United States (US). We aimed to explore potential racial/ethnic and sociodemographic disparities in the prevalence of syphilis in US pregnancies. We conducted a retrospective analysis of the Centers for Disease Control’s Natality Live Birth database (2016-2018). The prevalence of syphilis was compared among gravidas of different racial/ethnic groups using Pearson’s chi-square test with Bonferroni adjustment. Logistic regression explored the association between syphilis and maternal race/ethnicity, age, education level, type of medical insurance, no or late (≥2nd trimester) prenatal care, total number of prenatal care visits and smoking during pregnancy. Results were displayed as adjusted odds ratios (aOR) and 95% confidence intervals (CI), and statistical significance was set as p-value < 0.05. The cohort included 9,917 live births to women with syphilis during pregnancy (0.10% of the total 10,199,489). Non-Hispanic Blacks had the highest prevalence of syphilis, followed by Hispanics (p<0.001) (Figure). Of the sociodemographic parameters, non-Hispanic Black race and education level less than high school graduation were associated with the highest risk for syphilis in pregnancy (aOR 4.82, 95% CI 4.57-5.08, and OR 4.15, 95% CI 3.59-4.79, respectively). Additional significant risk factors included education level of high school graduation, Medicaid insurance, smoking during pregnancy, maternal age ≥ 40, Hispanic ethnicity, and no prenatal care (Table). We document significant racial/ethnic and sociodemographic disparities in the risk of syphilis in US pregnancies. Most prominently, black race and low education level among other sociodemographic factors were associated with a substantially increased risk for syphilis in pregnancy. These findings suggest that public health initiatives to improve education, prevention, and access to screening and treatment of syphilis, should focus on these vulnerable high-risk populations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

ASSOCIATION OF CONGENITAL ANOMALIES IN LIVE BIRTHS WITH THEIR OBSTETRIC-NEONATAL AND SOCIODEMOGRAPHIC PROFILES

ABSTRACT Objective: to identify the association of congenital anomalies in live births with the obstetric-neonatal and sociodemographic profile. Methods: an ecological study, conducted in 2019, with 251,444 live births, identified through the database of the Live Birth Information System of the Minas Gerais Health Secretariat. Descriptive statistics and binary logistic regression were adopted for the analysis. Results: 1,865 cases of anomalies (0.7%) were found, with predominance of deformity of the musculoskeletal system in 789 (42.3%) live births. The variables that presented a significant association with congenital anomalies were single mothers, age ≥35 years old, inadequately performed prenatal care initiated in the third trimester of pregnancy, double (or more) pregnancy, preterm births, cesarean delivery, fetal breech presentation, exclusive assistance by the medical professional during delivery, newborn with high-risk 5-minute Apgar score, low birth weight, and male gender. Conclusion: in 2019, the congenital malformations in the state of Minas Gerais were associated with single women, aged ≥35 years old, who underwent inadequate and late prenatal care, and with double or more pregnancies. In relation to the newborns, the malformations were associated with a high risk for late sequelae, weight between ≤1,000 g and &lt;2.500 g, and male gender.

Identifying Barriers and Facilitators to Prenatal Care for Spanish-Speaking Women.

BACKGROUND Early access to quality prenatal care is an essential component of improving maternal and neonatal outcomes as it allows for early intervention and risk stratification. Women who receive late or infrequent prenatal care are at high risk for complications including preterm birth, infant death, and stillbirth. We sought to better understand the barriers Spanish-speaking women face in accessing quality prenatal care and to identify facilitators in obtaining timely quality prenatal care.METHODS We recruited a homogeneous group of 11 women with Spanish as their primary language who were pregnant or had given birth within the last six months. We then conducted two focus groups in Spanish. The focus groups were recorded, translated, and transcribed, and then coded using grounded theory.RESULTS In our cohort of participants, the three major themes included desire for psychosocial support, health care system logistics, and barriers due to Latinx ethnicity.LIMITATIONS Our study has several limitations, including a small sample size and single site design.CONCLUSION Latinx women experience unique barriers to care including language barriers, a lack of cultural competency on the part of health care personnel, and ethnic discrimination. Additional research is needed to develop patient-centered interventions to address these barriers.

1142. Increased Odds of Psychiatric Illness Among Mothers of Infants with Congenital Syphilis

BackgroundSyphilis can be transmitted mother to child during pregnancy leading to multisystem birth defects if untreated. In Illinois, screening is mandated for pregnant women at first and third trimesters. The University of Illinois Hospital (UIH) serves a vulnerable patient population with a high syphilis prevalence. An understanding of risk factors associated with maternal syphilis infection can guide prevention of congenital syphilis (CS) with early prenatal diagnosis and treatment. The aim of this retrospective case control study is to describe maternal risk factors associated with CS in a clinical setting.MethodsUsing a database used for health department reporting from 2014-2018 at UIH, 106 maternal syphilis diagnoses were identified. Medical records were reviewed for CS infant diagnosis, sociodemographic information, medical history, and potential risk factors, including multiple sex partners, HIV status, drug use, history of incarceration or sex work, and having sex with men who have sex with men (MSM). Cases were matched with controls of pregnant women with syphilis testing that was not indicative of infection.ResultsOf the maternal syphilis diagnoses identified, there were 8 cases in which CS was possible or highly probable, 68 in which CS was less likely or unlikely, and 30 that were lost to follow up. Of the possible and probable infants’ mothers, 38% had a psychiatric illness (6.80 OR, 95% CI 1.06-43.48) and 25% were homeless (12.00 OR, 95% CI 0.94-153.89). Late or scant prenatal care was seen in 75% (4.15 OR, 95% CI 0.72-23.95) and 75% had inadequate syphilis treatment. None were HIV positive or reported incarceration, intravenous drug use, sex work, or having sex with MSM.ConclusionAmong infants with probable or possible CS, there was a 6.80 increased odds of maternal psychiatric illness compared to those born to mothers not diagnosed with syphilis, which may have complicated prenatal care and delayed diagnosis or treatment. Psychiatric illness outnumbered several other known risk factors; however, these may be less often discussed during clinical encounters. Psychiatric illness history may be a risk factor and means to identify women in the clinical setting who need close follow up and outreach after a prenatal syphilis diagnosis to prevent or mitigate congenital transmission.Disclosures All Authors: No reported disclosures