Prenatal screening for infectious diseases and opportunities for prevention.
OBJECTIVE
To characterize adherence with recommendations for prenatal infectious disease screening and missed opportunities for prevention of congenital and perinatal infections.


METHODS
Demographic, prenatal, and peripartum information was abstracted from labor and delivery records of a random, stratified sample of live births in 1998 and 1999 to residents of eight active surveillance areas. Adherence with prenatal screening recommendations was evaluated for hepatitis B, syphilis, rubella, human immunodeficiency virus (HIV), and group B streptococcus (GBS). Characteristics of missed opportunities for disease prevention were assessed by univariate and multivariable analysis to account for survey design.


RESULTS
Prenatal screening rates for hepatitis B surface antigen (HBsAg) (96.5%), syphilis (98.2%), and rubella (97.3%) were high. Areas of excess syphilis morbidity did not adhere to recommendations for third-trimester retesting. Testing rates for HIV (57.2%) and GBS (52.0%) were lower and had wide geographic variation. Postpartum rubella vaccination was documented for only 65.7% of rubella-susceptible women. Inadequate prenatal care was the single strongest predictor of missed opportunities for prenatal testing (relative risk 14.6; 95% confidence interval 6.3, 33.7). Blacks were less likely than whites to receive adequate prenatal care and prenatal tests, more likely to test positive for HBsAg and syphilis, and less likely to receive recommended prevention interventions such as postpartum rubella vaccination for susceptible women.


CONCLUSIONS
Adherence to both long-standing and more recent recommendations for congenital and perinatal disease prevention can be improved, thus perhaps reducing racial disparities in the use of prenatal screening and appropriate prevention interventions.
Schrag
Stephanie J
SJ
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. zha6@cdc.gov
Arnold
Kathryn E
KE
Mohle-Boetani
Janet C
JC
Lynfield
Ruth
R
Zell
Elizabeth R
ER
Stefonek
Karen
K
Noga
Heather
H
Craig
Allen S
AS
Thomson Sanza
Laurie
L
Smith
Glenda
G
Schuchat
Anne
A
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards*; D012189:Retrospective Studies; D012409:Rubella / Q000453:epidemiology / Q000517:prevention & control; D013290:Streptococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D013587:Syphilis / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology