Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

Wan, Zhihua; Zhang, Huan; Xu, Haigang; Hu, Yang; Tan, Cai; Tao, Yuling

doi:10.21203/rs.3.rs-33577/v2

Cited by 7 publications

(8 citation statements)

References 10 publications

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“…There was a significant relationship between birth asphyxia and women with syphilis infection. Maternal syphilis infection in pregnancy has been shown in other studies to lead to adverse birth outcomes including; spontaneous abortions, preterm birth, stillbirth and newborns who are small for gestational age [49]. Important to note is that, in Uganda, routine screening for syphilis is done at the initial antenatal visit and treatment offered to those who are infected [28].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with birth asphyxia among term singleton births at two referral hospitals in Northern Uganda: a cross sectional study

Ayebare

Hanson

Nankunda

et al. 2022

BMC Pregnancy Childbirth

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Background Birth asphyxia is one of the leading causes of neonatal mortality worldwide. In Uganda, it accounts for 28.9% of all neonatal deaths. With a view to inform policy and practice interventions to reduce adverse neonatal outcomes, we aimed to determine the prevalence and factors associated with birth asphyxia at two referral hospitals in Northern Uganda. Methods This was a cross-sectional study, involving women who gave birth at two referral hospitals. Women in labour were consecutively enrolled by the research assistants, who also attended the births and determined Apgar scores. Data on socio-demographic characteristics, pregnancy history and care during labour, were obtained using a structured questionnaire. Participants were tested for; i) malaria (peripheral and placental blood samples), ii) syphilis, iii) white blood cell counts (WBC), and iv) haemoglobin levels. The prevalence of birth asphyxia was determined as the number of newborns with Apgar scores < 7 at 5 min out of the total population of study participants. Factors independently associated with birth asphyxia were determined using multivariable logistic regression analysis and a p-value < 0.05 was considered statistically significant. Results A total of 2,930 mother-newborn pairs were included, and the prevalence of birth asphyxia was 154 [5.3% (95% confidence interval: 4.5- 6.1)]. Factors associated with birth asphyxia were; maternal age ≤ 19 years [adjusted odds ratio (aOR) 1.92 (1.27–2.91)], syphilis infection [aOR 2.45(1.08–5.57)], and a high white blood cell count [aOR 2.26 (1.26–4.06)], while employment [aOR 0.43 (0.22–0.83)] was protective. Additionally, referral [aOR1.75 (1.10–2.79)], induction/augmentation of labour [aOR 2.70 (1.62–4.50)], prolonged labour [aOR 1.88 (1.25–2.83)], obstructed labour [aOR 3.40 (1.70–6.83)], malpresentation/ malposition [aOR 3.00 (1.44–6.27)] and assisted vaginal delivery [aOR 5.54 (2.30–13.30)] were associated with birth asphyxia. Male newborns [aOR 1.92 (1.28–2.88)] and those with a low birth weight [aOR 2.20 (1.07–4.50)], were also more likely to develop birth asphyxia. Conclusion The prevalence of birth asphyxia was 5.3%. In addition to the known intrapartum complications, teenage motherhood, syphilis and a raised white blood cell count were associated with birth asphyxia. This indicates that for sustained reduction of birth asphyxia, appropriate management of maternal infections and improved intrapartum quality of care are essential.

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Section: Discussionmentioning

confidence: 99%

Factors associated with birth asphyxia among term singleton births at two referral hospitals in Northern Uganda: a cross sectional study

Ayebare

Hanson

Nankunda

et al. 2022

BMC Pregnancy Childbirth

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“…The other recommendation for adequate treatment of mother and foetus is that treatment of mother should be completed as early as possible but at least 4 weeks prior to delivery. A study reviewing pregnancy outcomes in women with syphilis in China found significantly higher incidence of adverse pregnancy outcomes in women who were classified as inadequately treated (completed treatment <4 weeks prior to delivery) compared with adequately treated women with an adjusted odds ratio for congenital syphilis of 3.63 (95% confidence interval 1.8-7.31) [49]. Congenital syphilis was not reported in any of the infants from mothers who received treatment in the first trimester, reflecting higher proportion of treatment adequacy when treatment was initiated earlier in pregnancy [49].…”

Section: Management Of the Pregnant Womanmentioning

confidence: 99%

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

Thean¹,

Moore²,

Nourse³

2022

Current Opinion in Infectious Diseases

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Purpose of reviewIn light of alarming increases in the incidence of congenital syphilis in many middle and higher income countries across the globe, this review summarizes recent changes in the epidemiology of syphilis, highlights recommended changes to testing in pregnancy and provides an update for the management of syphilis infection in pregnancy (SIP) and of the infant born to a mother with SIP.Recent findingsThe re-emergence of congenital syphilis is a result of increasing infectious syphilis in women of childbearing age, which is in turn a result of increasing syphilis in the general population particularly in Indigenous and marginalized populations. Potential reasons for the increase include changing sexual practices and increased travel and migration, as well as factors that limit healthcare access, particularly access to antenatal care and limited awareness and education amongst mothers and maternity services. A single antenatal test for syphilis is insufficient; more frequent testing in pregnancy is necessary even for women deemed to be low risk. The management of SIP and of the newborn is complex and guidelines should be readily available with clear recommendations.SummaryCongenital syphilis is preventable. The current crisis calls for a global and national multipronged, co-ordinated approach involving public health and hospital systems which includes education of individuals and healthcare workers, availability of updated guidelines for prevention and treatment, prioritization of antenatal testing, assurance of accessible and prompt treatment and appropriate assessment and follow-up of infants.

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“…Currently, most national studies have only investigated the relationship between treatment during pregnancy and pregnancy outcome in pregnant women with syphilis infection [8][9][10][11], and few studies have evaluated the relationship between their treatment during pregnancy and the conversion of syphilis-specific antibodies in those children exposed to syphilis. It is worth mentioning that the change in serological titers before and after treatment was not identical in each pregnant woman with syphilis infection.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Adverse Pregnancy Outcomes of Pregnant Women with Syphilis and Maternal-Infant Serological Association in Changzhou, China, 2015–2019

Bian

Qin

Zhang

et al. 2022

Stem Cells International

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Background. Although the prevention of mother-to-child transmission of syphilis program in China has achieved national coverage for 7 years, controversy still exists regarding the treatment of syphilis and the serological significance of syphilis. Objective. To explore the occurrence and influencing factors of adverse pregnancy outcomes among pregnant women with syphilis in Changzhou from 2015-2019 and to further analyze the impact of syphilis serologic titers on perinatal outcomes and neonatal serologic outcomes. Methods. Syphilis-infected pregnant women reported in Changzhou City from 2015 to 2019 were selected as the study population (data were obtained from the “China Information System for Prevention of Mother-to-child Transmission of AIDS, Syphilis and Hepatitis B.” Demographic characteristics, laboratory tests, and medication were collected to describe adverse pregnancy outcomes and the distribution of non-pale leptospiral antibody titers during pregnancy. Multivariate logistic regression was used to analyze the factors influencing adverse pregnancy outcomes. We also compared differences in syphilis titers among mothers who received different interventions, differences in serologic outcomes of their children, and correlations between them. Results. For mothers with syphilis infection, we found no treatment during pregnancy (OR =1.70) and an initial titer greater than 1 : 8 (OR =2.28) to be risk factors. For treated pregnant women, increasing age (OR =1.08), lack of standardized treatment (OR =1.87), and initial titer greater than 1 : 8 (OR =1.69) were risk factors, while previous parity was a protective factor (OR =0.62). For untreated pregnant women, marital status (OR =2.40) and initial titers greater than 1 : 8 (OR =3.57) were risk factors. There were statistically significant differences ( P < 0.01 ) in serologic titer changes, time to antibody regression, and time to exclusion of syphilis infection in children of pregnant women with syphilis infection after receiving different interventions during pregnancy, but different time distributions of interventions had no effect on these three indicators. Conclusion. Pregnant women with syphilis should actively cooperate with their doctors in the standardized treatment of pregnancy, and doctors should also pay more attention to pregnant women with syphilis whose initial titers are greater than 1 : 8. High-quality prenatal care is a key component in interrupting mother-to-child transmission of syphilis and preventing various adverse pregnancy outcomes. The adaptation of standardized treatment protocols for pregnant women with syphilis in China is a strong proof of the progress of precision medicine.

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Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

Cited by 7 publications

References 10 publications

Factors associated with birth asphyxia among term singleton births at two referral hospitals in Northern Uganda: a cross sectional study

Factors associated with birth asphyxia among term singleton births at two referral hospitals in Northern Uganda: a cross sectional study

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

Analysis of Adverse Pregnancy Outcomes of Pregnant Women with Syphilis and Maternal-Infant Serological Association in Changzhou, China, 2015–2019

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