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Identifying missed prevention opportunities: maternal and congenital syphilis in hospital records and birth certificates in California from 2011 to 2021

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

To examine maternal risk factors for congenital syphilis (CS).

Study design

We used a retrospective, population-based cohort of births in California (2011–2021) with linked birth certificates and hospital records. Modified Poisson regression models with robust standard errors were used to assess characteristics associated with CS. Among dyads with CS, maternal syphilis documentation was also examined.

Results

Of 4,481,096 births, 4659 (0.1%) had maternal syphilis without CS, and 2608 (0.06%) had both maternal syphilis and CS. CS was associated with having public insurance, tobacco use, drug use disorders, and residence in fringe-metro or medium/small-metro counties. Among CS dyads, 62.0% had no maternal syphilis documentation. There was a lower risk of no maternal syphilis documentation among those with <12th grade education; non-Hispanic Black identity; tobacco, cannabis, or drug use disorders; mental health conditions; and inadequate prenatal care.

Conclusions

Universal prenatal syphilis screening, treatment, and documentation are essential to preventing CS.

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Fig. 1: Trends in maternal and congenital syphilis from 2011-2021.

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Data availability

Due to restrictions from the Committee for the Protection of Human Subjects (CPHS), data cannot be released by the authors. Individuals may apply for California vital statistics and California Department of Health Care Access and Information (HCAI) data directly from the Health and Human Services Agency (HHSA). Stata code used in this analysis is available upon request from the corresponding author.

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Funding

This study was supported by the Study of Outcomes of Mothers and Infants (SOMI) at the University of California San Diego. Additional support was provided by the National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA) grant T32DA052142 to JF. NIH had no role in the study design, analysis, interpretation, writing, or decision to submit this study for publication.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of California San Diego, San Diego, CA, USA

    Jessica Frankeberger, Nana Matoba, Rebecca J. Baer & Christina Chambers

  2. Rady’s Children’s Hospital of San Diego, San Diego, CA, USA

    Nana Matoba

  3. Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA

    Rebecca J. Baer

Authors
  1. Jessica Frankeberger
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  2. Nana Matoba
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  3. Rebecca J. Baer
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  4. Christina Chambers
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Contributions

JF conceptualized the study, conducted the formal analysis, and wrote the original draft of the manuscript. RJB was responsible for data management and provided a curated dataset for the analysis. NM, RJ, and CC contributed to the conceptualization of the study, writing and interpretation of the results, and editing of the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Jessica Frankeberger.

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Competing interests

The authors declare no competing interests.

Ethics approval

All study protocols were approved by the Committee for the Protection of Human Subjects (CPHS) within the Health and Human Services Agency (HHSA) of the State of California and the Institutional Review Board at the University of California San Diego. The study was conducted in accordance with the Declaration of Helsinki, and we received a waiver for informed consent due to the nature of the administrative dataset and minimal risk of the study.

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Frankeberger, J., Matoba, N., Baer, R.J. et al. Identifying missed prevention opportunities: maternal and congenital syphilis in hospital records and birth certificates in California from 2011 to 2021. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02450-7

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