Screening for Gonorrhea and Chlamydia in Pregnancy: Room for Improvement

ObjectiveThis study sought to determine the proportion of pregnant women who are tested for gonorrhea and chlamydia as part of their prenatal care and to examine patient and provider factors affecting testing rates.MethodsThe study investigators conducted a retrospective chart review of all patients who delivered at St. Michael's Hospital, an urban tertiary care centre in Toronto, Ontario, between November 2015 and April 2016. Rates of testing and the prevalence of positive test results for gonorrhea and chlamydia were calculated. Chi-square tests were used to compare rates of testing among different types of prenatal care providers (obstetricians, maternal-fetal medicine specialists, family practitioners, midwives) and to determine whether testing rates were affected by patient demographics or characteristics. This study was a Canadian Task Force Classification II-2 retrospective cohort study.ResultsOf the 1315 women who delivered at St. Michael's Hospital during the study period, 1220 met inclusion criteria for the study. Of these women, 186 (15.3%) were not tested for gonorrhea and chlamydia during their pregnancy. There were 11 cases of chlamydia (1.1%) and no cases of gonorrhea. Testing rates were not affected by patient demographic variables or obstetrical history. Midwives and family physicians had the highest testing rates among the provider groups: 93.8% and 91.4%, respectively. Generalist obstetricians tested 88.5% of their patients. Maternal-fetal medicine specialists had a significantly lower rate of testing than the other provider groups, at 64.8% (P < 0.0001).ConclusionsFifteen percent of women were not tested for gonorrhea and chlamydia during the study period even though testing was recommended as part of routine prenatal care. Testing rates varied among providers, and strategies to improve these rates need to be explored.