Abstract
BackgroundSyphilis is responsible for a substantial burden of preventable adverse outcomes in pregnancy. The purpose of this study was to compare the frequency of adverse pregnancy outcomes among syphilis-seropositive women who received different treatment regimens at different times in Guangzhou, China.MethodsPregnant women with syphilis infection who received prenatal and delivery services in Guangzhou between January 2014 and December 2016 were included. Association between treatment status and the composite adverse outcomes (preterm birth, infant smaller than gestational age, stillbirth, and spontaneous abortion) was estimated.ResultsOf 1187 syphilis-seropositive pregnant women included in the analysis, 900 (75.8%) syphilis-seropositive pregnant women received treatment, and 287(24.2%) did not receive treatment. Adverse pregnancy outcomes were observed among 16.3% (147/900) of women with treatment and 33.8% (97/287) of women without treatment. Syphilis-seropositive pregnant women treated with one or two courses of penicillin had a similar risk of adverse pregnancy outcomes (adjusted RR = 1.36, 95% CI: 0.94–1.96). Adverse outcomes were more common among women whose non-treponemal serum test titer was >1:8 and received treatment after 28 weeks compared to before 28 weeks (adjusted RR = 2.34, 95% CI: 1.22–4.48).ConclusionsWomen who received one course of penicillin and women who received two courses of penicillin had a similar risk of adverse pregnancy outcomes. Syphilis treatment before 28 weeks of pregnancy is critical. Strategies to promote high-quality prenatal services are needed.
Highlights
Syphilis is responsible for a substantial burden of preventable adverse outcomes in pregnancy
Syphilis-seropositive pregnant women who elected to terminate their pregnancy (n = 94), with ectopic pregnancy (n = 31), with twin or multiple gestation pregnancies (n = 30), with absent information to indicate if they received syphilis treatment or not (n = 45), and with incomplete outcome information (n = 4) were excluded
We further examined the relationships between different treatments and adverse pregnancy outcomes, stratifying for non-treponemal serum test titer
Summary
Syphilis is responsible for a substantial burden of preventable adverse outcomes in pregnancy. The purpose of this study was to compare the frequency of adverse pregnancy outcomes among syphilis-seropositive women who received different treatment regimens at different times in Guangzhou, China. One million pregnant women are infected with syphilis each year [1] Many of these women do not receive testing and treatment, constituting a major missed public health opportunity. Data from the Chinese national surveillance system and World Health Organization both suggest the prevalence of syphilis infection among pregnant women in China is between 0.3–1.0% [6,7,8]. The city of Guangzhou has all medical institutions covered by the IPMTCT system and enhanced monitoring This provides a strong opportunity for research to better understand syphilis treatment among pregnant women
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