Perinatal & Pediatric
Prenatal characteristics and factors contributing to congenital syphilis: a descriptive analysis of cases reported to the Canadian Paediatric Surveillance Program between June 2021 and May 2023 Joanna Merckx* joanna merckx Geneviève Gravel Amandine Bemmo Kelly Baekyung Choi Jaskiran Sandhu Carsten Krueger Jared Bullard
Background: Congenital syphilis (CS) in Canada has surged in recent years, with incidence rates increasing from 2 to 32 confirmed cases per 100,000 livebirths from 2017 to 2022 (from 8 to 117 cases). Little is known about the prenatal characteristics and contributing factors to CS among the birthing parents (BP) of infants with in utero transmission of syphilis in Canada.
Methods: Paediatricians were invited through the Canadian Paediatric Surveillance Program to give an account of CS cases they attended to between June 2021 and May 2023. Data on cases meeting the study case definitions were collected voluntarily through a case-survey. We used descriptive statistics to examine prenatal health care access, diagnosis, and treatment as well as a subset of socio-economic and behavioral risk factors and determinants in BP.
Results: A total of 245 liveborn CS cases were reported from seven provinces and territories, including 71% from the prairies. The median age of BP was 27 years, 31% resided rurally. No prenatal care was reported in 25% (n=62) of BP, and only 25% (n=61) reported at least one visit per trimester. In a quarter (n=60) of the BP, no syphilis screening was performed during pregnancy. Prenatal treatment was not initiated among 20% (30/151) of the screened positives and was initiated <4 weeks pre-delivery in 35% (40/114). Syphilis coinfection with HIV and HCV were reported among 3% and 9% of BP, respectively. One out of six (18%) BP experienced housing insecurity or homelessness. Substance use prenatally was reported in 65% of the BP with use of stimulants and opioids in 60% and 31%, respectively.
Conclusion: In this country-wide picture, we identified substantial lack of access to care and care continuity in BP of liveborn diagnosed with CS. Public health action, such as community outreach to ensure prenatal care for and inclusion of all pregnant individuals, especially those with substance use, is pressing.