Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Screening Pregnant Women for Sexually Transmitted Infections (STI) and HIV

Summer 2004

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Size of the Problem

There are over 1,096,832 women of child-bearing age (15 to 44 years old) and over 68,000 babies born in Minnesota annually according to Minnesota health statistics [1]. Over 7,800 women were exposed to sexually transmitted infections in 2003. During the past seven years, Minnesota women infected with HIV have given birth to 168 babies [2,3].

Seriousness

Women affected by Sexually Transmitted Infections and HIV
Minnesota women, their partners and their infants are exposed to sexually transmitted (STIs). STIs are caused by a variety of bacteria, viruses and other organisms. Bacterial STIs such as chlamydia, gonorrhea, syphilis, perinatal group B streptococcal disease (GBS), and bacterial vaginosis can be cured with antibiotics.

Incidence of Sexually Transmitted Infections in Minnesota Women, 2000-2003
  # of Cases
Year Chlamydia Gonorrhea Syphillis
2000
5,856
1,681
5
2001
6,010
1,461
16
2002
7,352
1,688
4
2003
7,866
1,784
4

 

Women Living with HIV or AIDS, Minnesota 2000-2003
  # of Cases
Year HIV AIDS
2000
436
374
2001
525
283
2002
589
323
2003
631
373

STIs caused by viruses such as genital herpes, human papillomavirus, hepatitis B, and human immuno-deficiency virus (HIV) infection can not be cured. But most can be treated to relieve symptoms and help prevent complications.

If untreated, STIs can cause health problems ranging from mild, brief illness to serious complications such as infertility, tubal pregnancy, cancer, liver disease, and death. Many STIs can cause serious health conditions such as preterm birth, subsequent low birth weight, and death in infants born to infected mothers [4]. Most STIs cause no symptoms at first. A woman may not know she is infected until tested or until complications occur. STIs are passed from one person to another through vaginal, anal or oral sex.

Nationally, more than 20% of pregnant women have never been tested for HIV, despite Centers for Disease Control (CDC) recommendations [5].

Disparities
Nearly 19,000 US women are Hepatitis B carriers; 46% of those are Southeast Asians as compared to 21% of whites, 19% blacks, 11% Hispanics, and 3% others [6].

GBS is a leading cause of early neonatal infection and death in the US for infants <7 days old. Black infants are at higher risk than white infants. In 2002, the American College of Obstetricians and Gynecologists (ACOG) and the CDC revised guidelines for prevention of GBS. They recommended late prenatal screening of all pregnant women and intrapartum antibiotic prophylaxis for GBS carriers. According to the Active Bacterial Core Surveillance Program, which includes Minnesota data, rates declined 34% in 2003. Although racial disparities persist (black infants are 2.2 times more likely to have early-onset GBS than whites), rates for blacks now approach the 2010 Healthy People objective of 0.5 cases per 1,000 live births [7].

Perinatal transmission of the mother’s HIV infection to the baby can be prevented if the mother is treated during pregnancy. Of the 168 babies born to mothers infected with HIV in Minnesota over the past seven years:

  • 36% of the mothers were African American- although African Americans represent only 7% of all state births;
  • 30% of the 10 babies who became HIV infected during pregnancy/birth were African American;
  • Women of color were more likely than white mothers to be diagnosed with HIV after the birth of an infected baby;
  • 21% of the mothers were born in Africa;
  • 5% were American Indians and 6% were Hispanic.

Possible reasons for these disparities include:

  • The clinic/provider did not offer HIV testing during pregnancy/prenatal care;
  • The woman refused to be tested; and/or
  • The woman did not have prenatal care.
Births to HIV-Infected Women by Mother's Race/Ethnicity, Minnesota 1996-2002 (n=168)
Mother's Race/Ethnicity Percentage
African American
36%
White
30%
Afr Born
21%
Hispanic
6%
American Indian
5%
Asian
2%
Source: MDH. HIV/AIDS Perinatal Surveillance 2002

Economic
The CDC estimates that the lifetime cost of treating a person with HIV from the time of infection through the development of AIDS to death is $119,000 (1992 dollars). Programs that combine HIV counseling, testing, referral and partner notification services yield benefits of $20 for every $1 invested (1990 dollars) [8].

Interventions

Minnesota’s Hepatitis B Perinatal Prevention program, funded by the CDC recommends early screening of all pregnant women, education, immunization, and contact tracing.

The CDC currently recommends routine voluntary prenatal HIV-1 testing, preferably using the “opt out” consent, for all women in the United States with routine screening of infants whose mothers were not screened [9]. Efforts should be made to make universal testing of HIV during pregnancy more acceptable to women of all races and cultures. Offering these tests needs to be done in a culturally sensitive manner.

Effectiveness of Interventions
Screening and treatment for STIs and HIV during pregnancy has proven to be very successful in improving women and infants’ health and survival. However, success is only possible for those women who receive high quality early and adequate prenatal care [7,10].

Status

Minnesota Resources
Programs, resources, and strategies that promote STI and HIV screening and/or early and regular prenatal care include the following:

  • The Clinician’s Guide to Routine HIV Testing During Pregnancy released by MDH in 2003. Efforts are underway to have voluntary compliance in all regions of the state.
  • The Enhanced Perinatal Surveillance project was implemented by MDH in 2001
  • Local public health improved pregnancy outcome (IPO) projects
  • Statewide WIC programs
  • Twin Cities Healthy Start
  • Family Home Visiting programs
  • Tribal Health Initiatives
  • Health Plan Perinatal programs
  • Maternity Case Management Excellence Project
  • Culturally specific programs to reduce infant mortality funded by the MDH Eliminate Disparities in Health Initiative (EHDI)
  • Southwest MN Integrated Prenatal Project
  • Doula Programs
  • The Nest Incentive Programs
  • Save 10 Community Task Force.

Community Awareness
Because of the above initiatives that educate women and their partners about the importance of screening and treatment of STIs and early and adequate prenatal care, it is possible that there is growing community awareness of this topic. However, there are no data to demonstrate increased community awareness.

References

1. Minnesota Center for Health Statistics. 2003
2. MDH. Births to HIV-Infected Women and Perinatal HIV Infections, Minnesota 1996-2002. 2004.
3. MDH. STI and HIV Annual Reports for Minnesota. 2000, 2001, 2002, 2003.
4. CDC. National Center for Infectious Diseases. Addressing the Problem of Diseases of Pregnant Women and Newborns. 9-11-00 Accessed www.cdc.gov/ncidod/emergplan/pregnant_and_newborns [Attn: Non-MDH Link]
5. Kaiser Foundation. Kaiser Daily Reproductive Health Report. July 30, 2003. Accessed 8-1-2003 www.kaisernetwork.org/daily_reports [Attn: Non-MDH Link]
6. MDH. Perinatal Hepatitis B Program, Infectious Disease Epidemiology, Prevention and Control Division
7. CDC. Diminishing racial disparities in early-onset neonatal group B streptococcal disease-United States, 2000-2003. MMWR 6/18/04, 502-509.
8. CDC. An Ounce of Prevention- What Are the Returns? October 1999.
9. CDC. Advancing HIV prevention: new strategies for a changing epidemic- United States, 2003. MMWR. Morb Mortal Wkly Rep 2003. 52:329-332.
10. Editorial. Successes and Challenges in the Perinatal HIV-1 epidemic in the United States as illustrated by the HIV-1 Serosurvey of childbearing women. Arch Pediatric Adolesc Med. 158: 422-425. May, 2004.