(629) Factors associated with SUD in pregnant individuals with reactive syphilis screening at a safety-net hospital

Objective: Substance use disorder (SUD) has been defined as a barrier to adequate maternal syphilis treatment. The objective of this study was to evaluate characteristics associated with SUD among those with reactive syphilis screening at a large safety-net healthcare system to identify opportunities for intervention.

Study Design: Pregnant patients with syphilis before or during pregnancy from January 1, 2021 through December 31, 2022 were identified using reverse sequence screening in a large public healthcare system. Of these patients, those with SUD were identified via chart review. We compared maternal demographics, syphilis stage and initial nontreponemal titer, distance to prenatal clinic and preterm birth among those with and without SUD in pregnancy.

Results: Of 499 patients with syphilis before or during pregnancy identified with reverse sequence screening, 98 (19.6%) had documented SUD. Compared to those without SUD, those diagnosed with SUD and syphilis were more likely to be non-Hispanic white, multiparous, and with late and limited prenatal care (Table). The distance to prenatal clinic (miles [IQR]) was greater for individuals with SUD (11.6 [6.8-17.9] vs 8.5 [4.1-14.8] miles, p=0.01). There was no difference in initial RPR titers or syphilis stage, with the majority having latent syphilis (unknown duration or late). Preterm delivery was significantly more frequent among those with SUD (30% vs 9%, p 0.002).

Conclusion: In a high-risk prenatal cohort referred for reactive syphilis testing in a safety-net healthcare system, increased distance to the prenatal clinic, late prenatal care and increased preterm birth characterized those with SUD during pregnancy. Early identification of SUD and syphilis through targeted linkage-to-care for syphilotherapy and SUD recovery may decrease barriers to adequate maternal syphilis treatment.