Abstract
Background The World Health Organization estimated that about 1.36 million pregnant women suffered from syphilis in 2008, and nearly 66% of adverse effects occurred in those who were not tested or treated. Syphilis infection is one of the most common maternal factors associated with stillbirth. Objective This study aimed to determine the risk factors for stillbirth among pregnant women infected with syphilis. Methods In this retrospective study, data on stillbirth and gestational syphilis from 2010 to 2016 were extracted from the prevention of mother-to-child transmission (PMTCT) program database in the Zhejiang province. A total of 8,724 pregnant women infected with syphilis were included. Multiple logistic regression analysis was performed to determine the degree of association between gestational syphilis and stillbirth. Results We found that the stillbirth percentage among pregnant women infected with syphilis was 1.7% (152/8,724). Compared with live births, stillbirth was significantly associated with lower maternal age, not being married, lower gravidity, the history of syphilis, nonlatent syphilis stage, higher maternal serum titer for syphilis, inadequate treatment for syphilis, and later first antenatal care visit. In multiple logistic analysis, nonlatent syphilis (adjusted odds ratio (AOR) = 2.03; 95% CI = 1.17, 3.53) and maternal titers over 1 : 4 (AOR = 1.78; 95% CI = 1.25, 2.53) were risk factors for stillbirth, and adequate treatment was the only protective factor for stillbirth (AOR = 0.16; 95% CI = 0.10, 0.25). Conclusions Nonlatent syphilis and maternal titers over 1 : 4 were risk factors for stillbirth, and adequate treatment was the only protective factor for stillbirth.
Highlights
Stillbirth is a serious medical issue during childbirth
Stillbirths in women were significantly associated in univariate analysis with lower maternal age, not being married, lower gravidity, the history of syphilis, nonlatent syphilis stage, higher maternal
Using a multiple logistic regression analysis, we found that primary or secondary syphilis (adjusted odds ratios (OR) (AOR) 2.03; 95% confidence intervals (CI) 1.17, 3.53) and maternal titers over 1 : 4 (AOR 1.78; 95% CI 1.25, 2.53) were significant risk factors for stillbirth, after controlling for the influence of maternal age, marriage, gravidity, previous syphilis, syphilis treatment, and first ANC
Summary
The overall stillbirths worldwide have decreased markedly, from 4 million in 1990 to 2.1 million in 2015 [1], stillbirth estimates vary widely across geographic areas. Studies have shown that women who have experienced the loss of a baby through stillbirth were more likely to suffer from psychological distress and a higher risk of recurrence of stillbirth compared to women without a history of fetal loss [2,3,4,5]. Syphilis remains the most common congenital infection worldwide with tremendous consequences for both the mother and her developing fetus if it is left untreated. In 2012, an estimated 930,000 syphilis infections in pregnant women caused 143,000 early fetal deaths and stillbirths around the world [9]. In 2012, an estimated 930,000 syphilis infections in pregnant women caused 143,000 early fetal deaths and stillbirths around the world [9]. e wide adoption of syphilis screening and effective treatment with penicillin has made gestational syphilis entirely preventable
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