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

Abstract

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.

Adhesion to the monitoring of newborns from VDRL positive mothers

“…This finding was similar to those described elsewhere. 26,27,29 In this study, at birth and in the sixth month of life, 29.7% and 88.6% of newborns, respectively, had negative VDRL. The average time to newborn healing was 4.25 months of age.…”

Incidência de sífilis congênita e fatores associados à transmissão vertical da sífilis: dados do estudo Nascer no Brasil

“…Deve-se destacar a proporção de óbitos fetais entre os casos de sífilis congênita, seis vezes superior ao observado em mulheres sem diagnóstico de sífilis, e a elevada proporção de internação dos recém-natos, seja em UTI neonatal ou outros setores do hospital, com implicações para o financiamento do sistema de saúde. Esses resultados são coerentes com estudos de meta-análise recentes que encontraram risco aumentado de resultados perinatais adversos em mulheres com sífilis não tratada 10,20 , naquelas tratadas no terceiro trimestre da gestação 20 e naquelas com títulos sorológicos elevados antes do tratamento 20 . Verificou-se neste estudo que mulheres com transmissão vertical da infecção apresentaram início mais tardio da assistência pré-natal, menor proporção de número adequado de consultas, menor realização de uma ou duas sorologias para sífilis e menor registro de sorologias reagentes no cartão de pré-natal.…”

Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

“…Syphilis in pregnancy showed a threefold risk of both near miss and neonatal death in newborns with life-threatening conditions, when compared to those without life-threatening conditions in the final model (the association was statistically significant only for neonatal near miss). According to two meta-analyses, in the absence of appropriate treatment, half of pregnancies in women with syphilis result in adverse perinatal outcomes: abortion, stillbirth, neonatal death, prematurity, low birth weight, and infection 16,31 . Despite straightforward diagnosis and treatment, syphilis remains an important public health issue in Brazil.…”