Abstract
Mother-to-child transmission of syphilis remains a major global public health issue, and elimination of congenital syphilis is one of the millennium development goals of the World Health Organization (1). In 2012, an estimated 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes, including 143,000 early fetal deaths and stillbirths, 62,000 neonatal deaths, 44,000 preterm or low-weight births, and 102,000 infected infants worldwide (2). In China, the number of congenital syphilis cases reported annually increased from 468 in 2000 to 10,032 in 2013; the corresponding national congenital syphilis incidence rate increased nearly 26-fold, from 2.6 cases per 100,000 live births in 2000 to 69.9 in 2013 (3,4). To examine risk factors for mother-to-child transmission of syphilis, a cohort of pregnant women with a new syphilis diagnosis and their live-born infants was recruited during July 2011-July 2014 in Suzhou, in eastern China. Multivariable logistic regression results demonstrated that gestational age >36 weeks at the time of maternal syphilis diagnosis, higher maternal titers of rapid plasma reagin (RPR) and higher Treponema pallidum particle agglutination assay (TPPA) titers are risk factors for congenital syphilis. Among women with syphilis diagnosed at >36 weeks' gestational age, three quarters were migrant women. Recommendations for strengthening community and provider education about mother-to-child transmission of syphilis, early diagnosis and timely treatment of syphilis in pregnancy, and improving and providing access to prenatal care and screening migrant pregnant women with temporary residence status might reduce the incidence of congenital syphilis in China.
Highlights
Univariate logistic regression analysis indicated that delivery of an infant with congenital syphilis was significantly more likely among migrant women (OR = 4.9; confidence intervals (CIs) = 1.7–17.7) and women who received a diagnosis of maternal syphilis after 36 weeks’ gestational age (OR = 24.1; CI = 3.6–≥1,000.0) (Table 1)
Multivariable logistic regression demonstrated that mothers with syphilis diagnosed at >36 weeks’ gestational age were approximately 25 times more likely to deliver a baby with congenital syphilis than were women who received a diagnosis of syphilis at gestational age ≤12 weeks (Table 2)
* Confidence intervals and p-values from univariate exact logistic regression. † p
Summary
Risk Factors for Congenital Syphilis Transmitted from Mother to Infant — Suzhou, China, 2011–2014. To examine risk factors for mother-tochild transmission of syphilis, a cohort of pregnant women with a new syphilis diagnosis and their live-born infants was recruited during July 2011–July 2014 in Suzhou, in eastern China. Univariate logistic regression analysis indicated that delivery of an infant with congenital syphilis was significantly more likely among migrant women (OR = 4.9; CI = 1.7–17.7) and women who received a diagnosis of maternal syphilis after 36 weeks’ gestational age (OR = 24.1; CI = 3.6–≥1,000.0) (Table 1). Multivariable logistic regression demonstrated that mothers with syphilis diagnosed at >36 weeks’ gestational age were approximately 25 times more likely to deliver a baby with congenital syphilis than were women who received a diagnosis of syphilis at gestational age ≤12 weeks (aOR = 25.0; CI = 2.5–≥1,000.0) (Table 2).
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