Screening for Gonorrhea and Chlamydia in Pregnancy: Room for Improvement

Published:April 03, 2019DOI:



      This 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.


      The 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.


      Of 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).


      Fifteen 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.



      Cette étude visait à déterminer la proportion de femmes enceintes qui subissent un dépistage de la gonorrhée et de la chlamydia dans le cadre de leurs soins prénataux et à examiner les facteurs relatifs aux patientes et aux fournisseurs influençant cette proportion.


      Les chercheurs ont effectué un examen rétrospectif des dossiers de toutes les patientes qui ont accouché à l'Hôpital St. Michael's, un centre de soins tertiaires en milieu urbain à Toronto (Ontario), entre novembre 2015 et avril 2016. Le taux de dépistage de la gonorrhée et de la chlamydia et la prévalence de résultats positifs ont été calculés. Des tests du chi carré ont été utilisés dans le but de comparer le taux de dépistage selon les types de fournisseurs de soins prénataux (obstétriciens, spécialistes en médecine fœtomaternelle, omnipraticiens, sages-femmes) et de déterminer si le taux était influencé par les caractéristiques démographiques ou autres des patientes. Il s'agissait d'une étude de cohorte rétrospective conforme à la classification II-2 du Groupe d'étude canadien.


      Des 1315 femmes qui ont accouché à l'Hôpital St. Michael's durant la période à l'étude, 1 220 respectaient les critéres d'inclusion de l'étude. Parmi celles-ci, 186 (15,3 %) n'avaient pas subi de dépistage de la gonorrhée ou de la chlamydia durant leur grossesse. Il y avait 11 cas de chlamydia (1,1 %) et aucun cas de gonorrhée. Le taux de dépistage n'était pas influencé par les caractéristiques démographiques ou les antécédents obstétricaux des patientes. Les sages-femmes et les médecins de famille présentaient les plus hauts taux de dépistage : 93,8 % et 91,4 %, respectivement. Les obstétriciens généralistes soumettaient au dépistage 88,5 % de leurs patientes. Quant aux spécialistes en médecine fœtomaternelle, leur taux de dépistage était beaucoup plus faible que celui des autres groupes de fournisseurs, soit 64,8 % (P < 0,0001).


      Durant la période à l'étude, 15 % des femmes n'ont pas subi de dépistage de la gonorrhée et de la chlamydia, même si celui-ci est recommandé dans le cadre des soins prénataux habituels. Le taux de dépistage variait selon les fournisseurs, et des stratégies pour l'augmenter devront être explorées.

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