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

Abstract

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.

Syphilis in Pregnancy and Congenital Syphilis: Reality in a Portuguese Central University Hospital

“…17 Overall, all studies showed a lower prevalence of adverse outcomes between women who had received an intervention in the first or second trimesters of pregnancy. 13 Of those who did not undergo syphilis screening and treatment until the 3rd trimester, Hawkes et al 13 With regard to our well-treated CS case, the first penicillin administration was at 30 WG, although the exact time of infection was unknown (latent syphilis of unknown duration). On the other hand, regarding the other case of proven CS, the diagnosis was at delivery, and no treatment was instituted.…”

“…3,13 However, coverage of the 1st trimester screening and timely antenatal treatment are still a problem.…”

Análise dos casos de sífilis gestacional e congênita nos anos de 2008 a 2010 em Fortaleza, Ceará, Brasil

“…In Brazil, although improvements have been made to prenatal coverage indicators, good coverage and providing a minimum of six medical consultations, have not been sufficient to guarantee quality healthcare 19,22,23 . Studies also show the importance of providing quality prenatal care with an early diagnosis of syphilis in pregnant mothers, and highlight the outcome that inadequate treatment given to the mother has in relation to infant morbimortality [24][25][26][27] . Syphilis can be transmitted to a baby from the 9 th week of pregnancy onwards, although this occurs more frequently between the 16 th and 28 th week 2 , which thereby underlines the need for early diagnosis and treatment.…”

An eight-year retrospective analysis of antenatal screening results for syphilis: is it still cost effective?

“…Infections, as well as prematurity and birth asphyxia, contribute to 80% of neonatal deaths, and it has been shown that improving healthcare programs (including syphilis screening) beginning from the antenatal period would avert neonatal and infant deaths in order to attain the fourth MDG [27,28]. For the worldwide elimination of mother-to-child transmission of syphilis, one of the important steps defined in the report was "early antenatal care", which was found in a meta-analyses to decrease adverse pregnancy outcomes caused by syphilis infection of the mother when compared to pregnant women seen at the third trimester (odds ratio, 2.24) [29]. In some countries where seropositivity prevalence rates of syphilis are high or new seroconversion cases are detected during ongoing pregnancies, and where the population is composed of various ethnic and social characteristics, revision of the screening protocol is a question for antenatal care management policies.…”