Syphilis-attributable adverse pregnancy outcomes in China: a retrospective cohort analysis of 1187 pregnant women with different syphilis treatment

Abstract

Background 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. Methods Pregnant 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. Results Of 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). Conclusions Women 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.

Risk factors for stillbirth among pregnant women infected with syphilis from 2010–2016, Zhejiang Province, China

“…The results were consistent with large numbers of other reports [12,17,19,21,[22][23][24][25]. Although in most studies, higher maternal titers were defined as serum titers over 1:8, which were more commonly regarded as risk factors for adverse pregnancy outcomes [19,26], we used a maternal titer threshold of 1:4, and this still greatly increased the occurrence of stillbirth. In our province, maternal titers were checked monthly to keep them under 1:4 or to achieve a 4-fold reduction by delivery.…”

Risk Factors for Stillbirth among Pregnant Women Infected with Syphilis in the Zhejiang Province of China, 2010–2016

“…These results were consistent with other reports looking at stillbirths in pregnant women with syphilis in many countries including the United States [ 12 , 17 , 19 , 21 – 25 ]. In most studies, high maternal titers, defined as serum titers over 1 : 8, were regarded as a risk factor for adverse pregnancy outcomes [ 19 , 26 ]; however, we used a maternal titer threshold of 1 : 4 to define high titer, and it still correlated with greatly increased occurrence of stillbirth in these women. In the Zhejiang province, maternal titers were checked monthly to keep them under 1 : 4 or to achieve a 4-fold reduction in them by delivery.…”

Congenital syphilis: A contemporary update on an ancient disease

“…Best outcomes are seen when treatment occurs early in pregnancy and >30 days before delivery. [60][61][62] A recent retrospective review found that adverse pregnancy outcomes were significantly lower when maternal treatment occurred before 28 weeks underscoring the importance of early diagnosis and treatment. 62…”

“…Although the optimal timing of treatment during pregnancy is unknown, there is a direct correlation between treatment timing and adverse pregnancy outcomes, including CS rates. Best outcomes are seen when treatment occurs early in pregnancy and >30 days before delivery 60‐62 . A recent retrospective review found that adverse pregnancy outcomes were significantly lower when maternal treatment occurred before 28 weeks underscoring the importance of early diagnosis and treatment 62 …”