A risk model for congenital syphilis in infants born to mothers with syphilis treated in gestation: a prospective cohort study

Liu, Jiangbo; Hong, Fu-Chang; Peng, Pan; Zhou, Hua; Yang, Fan; Cai, Yu-Mao; Wen, Lizhang; Yonghui, Lai; Liu, Lin; Zeegers, Maurice P.

doi:10.1136/sti.2009.037549

Cited by 35 publications

(19 citation statements)

References 20 publications

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“…The characteristics of included studies involving 11398 women with syphilis and 43342 women without syphilis and published between 1917 and 2013 were summarized in Table 1. Forty-five studies [22]–[24], [32]–[73] were conducted in China, one [12] in UK, three in USA [13]-[14], [17], one [15] in Zambia, one [16] in Malawi, one [18] in Kenya, one [19] in Tanzania, and one [21] in Russia. All articles belonged to observational studies including retrospective cohort studies, retrospective cases analysis, prospective cohort studies, and prospective surveillance.…”

Section: Resultsmentioning

confidence: 99%

Reported Estimates of Adverse Pregnancy Outcomes among Women with and without Syphilis: A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundTo estimate probability of adverse pregnancy outcomes (APOs) among women with and without syphilis through a systematic review of published literatures.Methodology/Principal FindingsChinese and English literatures were searched for studies assessing pregnancy outcomes in the presence of maternal syphilis through August 2013. The prevalence estimates were summarized and analyzed by meta-analysis. Fifty-four literatures involving 11398 syphilitic women and 43342 non-syphilitic women were included from 4187 records initially found. Among untreated mothers with syphilis, pooled estimates were 76.8% for all APOs, 36.0% for congenital syphilis, 23.2% for preterm, 23.4% for low birth weight, 26.4% for stillbirth or fetal loss, 14.9% for miscarriage and 16.2% for neonatal deaths. Among syphilitic mother receiving treatment only in the late trimester (>28 weeks), pooled estimates were 64.4% for APOs, 40.6% for congenital syphilis, 17.6% for preterm, 12.4% for low birth weight, and 21.3% for stillbirth or fetal loss. Among syphilitic mothers with high titers (≥1∶8), pooled estimates were 42.8% for all APOs, 25.8% for congenital syphilis, 15.1% for preterm, 9.4% for low birth weight, 14.6% for stillbirth or fetal loss and 16.0% for neonatal deaths. Among non-syphilitic mothers, the pooled estimates were 13.7% for all APOs, 7.2% for preterm birth, 4.5% for low birth weight, 3.7% for stillbirth or fetal loss, 2.3% for miscarriage and 2.0% for neonatal death. Begg's rank correlation test indicated little evidence of publication bias (P>0.10). Substantial heterogeneity was found across studies in the estimates of all adverse outcomes for both women with syphilis (I 2 = 93.9%; P<0.0001) and women without syphilis (I 2 = 94.8%; P<0.0001).Conclusions/SignificanceSyphilis continues to be an important cause of substantial perinatal morbidity and mortality, which reminds that policy-makers charged with resource allocation that the elimination of mother-to-child transmission of syphilis is a public health priority.

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Section: Resultsmentioning

confidence: 99%

Reported Estimates of Adverse Pregnancy Outcomes among Women with and without Syphilis: A Systematic Review and Meta-Analysis

et al. 2014

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“…This is consistent with a review suggesting that 9.5% of all HIV-infected adults are co-infected with syphilis. 16 Prior studies show that inadequate prenatal care appears to be the biggest contributor to delivering an infant with congenital syphilis, but the magnitude of VDRL titers, 17-20 gestational week of syphilis treatment, 21 low maternal socioeconomic status, 22 multiple sexual partners 22 and maternal drug use 18 could all contribute to this outcome. Our results are unique in that they focus specifically on an HIV infected population, but are similar to the above studies showing that alcohol use during pregnancy and non-white ethnicity are associated with HIV infected mothers being co-infected with syphilis.…”

Section: Discussionmentioning

confidence: 99%

Syphilis in HIV-infected Mothers and Infants

Yeganeh

Watts

Camarca

et al. 2015

Pediatric Infectious Disease Journal

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Background Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low and middle income countries where both diseases are common. Methods We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. The present analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants. Results Approximately 10% (n=171) of women enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% (n=24) infants were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared to HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (AOR 2.5, 95% CI 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI 1.3-3.4), with 88% of HIV infections being acquired in-utero. As compared to HIV infected or HIV exposed infants, co-infected infants were significantly more likely to be born to mothers with VDRL titers ≥1:16 (AOR 3, 95% CI 1.1-8.2) and higher viral loads (AOR 1.5 95% CI 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected. Conclusion Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates.

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“…The likelihood of transmission (and hence the risk of adverse outcome) will vary according to both the stage of syphilis infection in the mother (primary, secondary or latent) [2], and the timing of any intervention delivered during the pregnancy [3], [4].…”

Section: Introductionmentioning

confidence: 99%

Early Antenatal Care: Does It Make a Difference to Outcomes of Pregnancy Associated with Syphilis? A Systematic Review and Meta-Analysis

2013

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ObjectiveDespite an increase in the proportion of women who access antenatal care, mother-to-child transmission of syphilis continues to be a consequence of undiagnosed, untreated, or inadequately treated maternal syphilis. We reviewed evidence on the optimal timing of antenatal interventions to prevent mother-to-child transmission of syphilis and its associated adverse outcomes.DesignSystematic review and meta-analysis of published literature. English-language articles were included if they (1) reported the gestational age at which the mother was screened or tested for syphilis; (2) reported on pregnancy outcome. No publication date limits were set.ResultsWe identified a total of 1,199 publications, of which 84 were selected for further review and five were included. All showed a lower prevalence of any adverse outcome among women who received an intervention (to include screening and treatment) in the first and second trimesters of pregnancy compared to the third trimester. The overall odds ratio for any adverse outcome was 2.24 (95% CI 1.28, 3.93). All sub-analyses by type of outcome presented important heterogeneity between studies, except for those studies reporting an infected infant (odds ratio 2.92, 95% CI 0.66, 12.87; I2 = 48.2%, p = 0.165).ConclusionsOur review has shown that the timing of antenatal care interventions makes a significant difference in the risk of having an adverse outcome due to syphilis. Women who sought care in the first two trimesters of their pregnancy, and received the appropriate intervention, were more likely to have a healthy infant, compared to women screened and treated in the third trimester. Encouraging ALL pregnant women to seek care in the first two trimesters of their pregnancy should be a priority for health programmes. For interventions to be effective within these health programmes, health systems and community engagement programmes need to be strengthened to enable pregnant women to seek antenatal care early.

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A risk model for congenital syphilis in infants born to mothers with syphilis treated in gestation: a prospective cohort study

Abstract: The risk of CS could be predicted by the interaction between GW x log (1/T). Early treatment given to women with syphilis during antenatal care may be the only effective method to decrease the risk of CS.

Cited by 35 publications

References 20 publications

Reported Estimates of Adverse Pregnancy Outcomes among Women with and without Syphilis: A Systematic Review and Meta-Analysis

Reported Estimates of Adverse Pregnancy Outcomes among Women with and without Syphilis: A Systematic Review and Meta-Analysis

Syphilis in HIV-infected Mothers and Infants

Early Antenatal Care: Does It Make a Difference to Outcomes of Pregnancy Associated with Syphilis? A Systematic Review and Meta-Analysis

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