Associations Between Maternal Mental Health and Congenital Syphilis Birth Outcomes: Analysis of Georgia Surveillance Data, 2018-2023.

BACKGROUND

Congenital syphilis (CS) is a preventable yet persistent public health problem in the United States. Maternal mental health conditions (MMHC) during pregnancy may contribute to missed prevention opportunities, but their association with CS outcomes is unclear.

METHODS

Georgia sexually transmitted infections (STI) surveillance data (2018-2023) were analyzed to assess prebirth MMHC mentions among syphilis-affected pregnancies, their association with CS, and variation by maternal household composition as a proxy for immediate social support. MMHC mentions were identified using rule-based analysis of free-text case narratives from the year before delivery. Modified Poisson regression was used to estimate adjusted prevalence ratios (aPR), and an internal validation substudy informed probabilistic bias adjustment for MMHC misclassification.

RESULTS

Among 1684 syphilis-affected pregnancies, 416 (25%) resulted in CS. Prebirth MMHC were documented in 4% and were associated with higher CS prevalence (aPR, 1.5; 95% confidence interval [CI], 1.1-2.1). Although the association did not differ significantly by maternal household composition, it was attenuated among women living with family or partners (aPR, 1.18; 95% CI, 0.57-2.47) compared with those living alone or with nonfamily members (aPR, 1.42; 95% CI, 0.70-2.90). Internal validation indicated MMHC under-ascertainment in surveillance data; bias-adjusted analyses suggested a stronger association with CS, albeit with considerable uncertainty (bias-adjusted PR, 2.1; 95% simulation interval, 0.8-5.0).

CONCLUSIONS

Prebirth MMHC mentions captured during STI case investigations were associated with increased CS prevalence and may serve as an early indicator of vulnerability. Incorporating mental health-informed follow-up into STI surveillance workflows could enhance care coordination and strengthen CS prevention.