Screening for Sexually Transmitted Infections during pregnancy: Is healthcare meeting expectations?

BACKGROUND: Sexually transmitted infections (STIs) during pregnancy contribute to adverse maternal and neonatal outcomes. Guidelines from the U.S. Centers for Disease Control and Prevention (CDC), and American College of Obstetricians and Gynecologists (ACOG), recommend routine screening for syphilis, HIV, chlamydia, gonorrhea, and risk-based screening for trichomoniasis for pregnant women. We assessed pre-COVID-19 prenatal STI screening patterns among privately insured pregnant persons in the United States to assess whether practice aligns with guidelines. METHODS: We conducted a retrospective descriptive analysis of pregnancies among persons aged 15-44 years captured in the Merative MarketScan® commercial claims database from 2016-2019. Pregnancies were identified using ICD-10, CPT-4, and HCPCS codes and classified by delivery type. Screening coverage was summarized overall and by pregnancy outcome, age group, and metropolitan statistical area. RESULTS: Among 917,859 pregnancies, overall screening coverage was highest for syphilis (90.5 %), followed by HIV (82.4%), chlamydia (80.4%), and gonorrhea (79.5%), while trichomoniasis screening was substantially lower (22.4%). Screening was lowest among pregnancies ending in spontaneous abortion and declined with increasing maternal age for chlamydia, gonorrhea, and trichomoniasis. Urban rural differences were small, with slightly higher screening in urban areas. CONCLUSIONS: We provide a pre-COVID-19 baseline for prenatal STI screening among privately insured pregnant persons. STI screening adherence was high, but further progress is needed to mitigate STIs' costly but preventable health outcomes.