Alignment of Technology, Policy and Law Result in 200% Increase in Perinatal STI Identification

Background:
STIs during pregnancy contribute to adverse outcomes. Prenatal care access has improved in recent decades. Reduced perinatal transmission has been reported while practitioner screening practices remain inconsistent. Outcomes such as low birth weight rates have remained level.

Objective:
Describe how new law and application of technology influenced enhanced capacity for case identification. .

Method:
Long range plan implemented to change laws, develop surveillance technology, expand ELR and revise processes in order to better identify infections during pregnancy. Analysis of system data from 2007 compared prior decade of perinatal and neonatal reports. Cases were hot-linked to birth records to capture outcomes. Descriptive, bivariate and logistic regression analysis supported by SPSS.

Result:
After two years of focused effort law change expanded the scope of authority to require STD testing during pregnancy. Code changed the number of infections, frequency and test technology required during pregnancy. Surveillance application supported revised processes for enhanced data collection. Identification of infection during pregnancy went from 3,500 case reports in each of the prior three years to 10,952 during 2007. This indicates that 5.4% of births were associated with a STI. Preliminary analyses of available data indicate treatment during pregnancy for 47% of chlamydia, 42% of gonorrhea, and 34% of syphilis. Thirteen percent of those in prenatal care received more than 10 visits. Of those in prenatal care 84% received treatment for their infection.

Conclusion:
The tripled case identification highlighted that prevalence during pregnancy is significant. The need for improvement is recognized e.g., rate of treatment completion, scope of prenatal care visits. Distributions of infections between races while disproportionate among minorities indicate higher than national rates among non-Hispanic whites.

Implications:
Evaluation of health care delivery systems may identify which groups of women are at-risk for inadequate treatment, and potential pregnancy related complications. Significant policy implications exist for discussion with prenatal care providers/insurers.