Shanghai First Maternity and Infant Hospital/Tongji University, Shanghai Women's Health Institute, Shanghai, China.
Int J Infect Dis. 2010 Sep;14 Suppl 3:e45-8. doi: 10.1016/j.ijid.2009.09.009. Epub 2010 Feb 6.
To assess the trends and determinants of maternal and congenital syphilis in Shanghai, China.
We conducted a prospective cohort study of maternal and congenital syphilis from 2002 to 2006 in Shanghai, China. We presented the trends of maternal syphilis and congenital syphilis rates and compared outcomes in infants born to mothers with complete versus incomplete treatment for maternal syphilis. We also assessed the determinants of compliance to treatment of maternal syphilis and examined the associations of initial maternal RPR antibody level and gestational age at initiation of treatment with occurrence of congenital syphilis.
A total of 535 537 pregnant women were included in the analysis. During this period of time, 1471 maternal syphilis cases (298.7 per 100 000 live births) and 334 congenital syphilis cases (62.4 per 100 000 live births) were identified. Both maternal and congenital syphilis rates increased from 2002 until 2005, with a slight decrease in 2006. The rate of maternal syphilis was 156.2 per 100 000 live births in Shanghai residents and 371.7 per 100 000 live births in the migrating population (p<0.001). The compliance to treatment for maternal syphilis was poorer in women with a lower level of education. The rate of congenital syphilis in infants born to mothers with incomplete treatment (50.8%) was much higher than in infants born to mothers with complete treatment (12.5%). Rates of fetal death, neonatal death, and major birth defects were 30.4%, 11.0%, and 3.8%, respectively, in the incomplete treatment group; the corresponding figures were 5.5%, 0.56%, and 0.46%, respectively, in the complete treatment group. Infant outcome was also affected by initial maternal RPR antibody level and time of treatment, with much better outcomes in mothers with low antibody levels and earlier treatment.
There has been a resurgence of congenital syphilis in Shanghai, China, especially in the migrating population and other populations with a lower socioeconomic status.
评估中国上海地区的孕产妇及先天梅毒的流行趋势及其影响因素。
我们在中国上海开展了一项前瞻性队列研究，研究对象为 2002 年至 2006 年期间的孕产妇及先天梅毒病例。我们呈现了孕产妇梅毒及先天梅毒的发生率变化趋势，并比较了接受全程及非全程治疗的孕产妇所产婴儿的结局。我们还评估了孕产妇梅毒治疗依从性的影响因素，并分析了初始孕产妇快速血浆反应素（RPR）抗体滴度和治疗起始时的孕龄与先天梅毒发生的关联。
共纳入 535 537 名孕妇。在此期间，共检出 1471 例孕产妇梅毒病例（298.7/10 万活产）和 334 例先天梅毒病例（62.4/10 万活产）。孕产妇梅毒及先天梅毒的发生率均从 2002 年持续升高，至 2005 年达到高峰，2006 年略有下降。上海本地居民的孕产妇梅毒发生率为 156.2/10 万活产，流动人口为 371.7/10 万活产（p<0.001）。文化程度较低的孕产妇治疗依从性较差。非全程治疗孕产妇所产婴儿的先天梅毒发生率（50.8%）明显高于全程治疗者（12.5%）。非全程治疗组的胎儿及新生儿死亡率、严重先天缺陷发生率分别为 30.4%、11.0%和 3.8%，全程治疗组分别为 5.5%、0.56%和 0.46%。初始孕产妇 RPR 抗体滴度及治疗起始时间也影响婴儿结局，低滴度及早治疗者的结局较好。
中国上海地区的先天梅毒出现了回升，尤其是流动人口及其他社会经济地位较低的人群。
