title: Congenital syphilis in Maryland, 1989-1991: the effect of changing the case definition and opportunities for prevention.
abstract: BACKGROUND
  The reported incidence of congenital syphilis in the United States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been published regarding missed opportunities for prenatal intervention.
  
  
  OBJECTIVE
  To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congenital syphilis incidence or a change in the surveillance case definition, and to describe missed opportunities for prenatal intervention.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  RESULTS
  When the revised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mothers had received no prenatal care. Among those whose mothers had received prenatal care, opportunities to intervene were missed for 53%.
  
  
  CONCLUSIONS
  Although a true increase in congenital syphilis incidence occurred before 1990, the increase reported in Maryland between 1989 and 1991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.
authors.affiliation: Epidemic Intelligence Service, Division of Field Epidemiology, Epidemiology Program Office, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Thompson
authors.forename: D
authors.initials: D
authors.lastname: Matuszak
authors.forename: D M
authors.initials: DM
authors.lastname: Dwyer
authors.forename: A
authors.initials: A
authors.lastname: Nakashima
authors.forename: H
authors.initials: H
authors.lastname: Pearce
authors.forename: E
authors.initials: E
authors.lastname: Israel
mesh_terms: D000293:Adolescent; D000328:Adult; D015982:Bias; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008396:Maryland / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors; D013590:Syphilis, Congenital / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control