Based on coverage from Global News, News-Medical, Times Colonist, EurekAlert!, and The Peterborough Examiner.
A new Ontario study is raising an uncomfortable question for a publicly funded health system: why are so many pregnant people missing a basic blood test that can prevent babies from being born with a serious, sometimes fatal infection?
Researchers analyzing provincial health data say syphilis screening is falling through the cracks for a significant share of pregnancies, with the biggest gaps showing up among people who already face the steepest barriers to prenatal care.
Ontario study finds screening gaps
The research, published May 19 in the Canadian Medical Association Journal (CMAJ), looked at health administrative data from 551,706 pregnancies in 446,660 people in Ontario between 2018 and 2023.
The headline finding: about one in five pregnancies did not receive timely syphilis screening, which guidelines recommend in the first trimester or at the initial prenatal visit.
Co-author Dr. Sahar Saeed, an assistant professor in the Department of Public Health Sciences at Queen’s University in Kingston, wrote that “in a publicly funded health care system, 1 in 5 pregnancies did not receive timely syphilis screening,” pointing to persistent gaps in coverage.
Syphilis in pregnancy can be devastating
Syphilis is a sexually transmitted infection that can be passed from mother to baby during pregnancy or delivery. If it is not treated with antibiotics, it can lead to severe outcomes, including infant death.
The study and related reporting underline why timing matters. The sooner syphilis is diagnosed and treated during pregnancy, the lower the risk of outcomes such as miscarriage, stillbirth, preterm birth, developmental delay, blindness, and deafness.
Treatment is relatively straightforward: one to three shots of benzathine penicillin, depending on the stage of infection.
What the data shows in Ontario
The numbers in the study put some hard edges on the problem:
- 8% of pregnant people were not screened for syphilis at all. - 79% were screened in the first trimester. - Among pregnancies that were screened, about 3% were screened late, in the third trimester or at delivery.
The Canadian Press report, drawing from the same research, adds that more than 44,000 pregnant people were not screened when they should have been early in pregnancy. It also says more than 13,000 were screened late, in the third trimester or at delivery.
Those aren’t small misses. Late screening can mean less time to treat, fewer chances to prevent transmission, and a higher risk of serious harm to the baby.
Marginalized communities face bigger barriers
Saeed and her co-authors say gaps in access to prenatal care were especially pronounced in marginalized communities facing the greatest barriers. The CMAJ report links late screening with sociodemographic and behavioural risk factors that may also be tied to an increased likelihood of inadequate access to prenatal care.
Put plainly: the people least likely to get early, consistent prenatal care also appear to be the ones most likely to get missed by routine screening systems.
What researchers suggest next
The authors argue that relying only on traditional prenatal care models may not be enough to reach everyone. They point to “opportunistic screening” and community-based outreach programs using point-of-care testing, paired with nonjudgmental, comprehensive care, as a practical next step.
With syphilis rates rising in Canada over the last decade, the study’s message for Ontario is straightforward: the tools to prevent congenital syphilis already exist, but the system has to reach people early enough for those tools to work.
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