Institute of Global Health, University College London, London, UK.
Lancet Infect Dis. 2011 Sep;11(9):684-91. doi: 10.1016/S1473-3099(11)70104-9. Epub 2011 Jun 15.
About 2·1 million pregnant women have active syphilis every year. Without screening and treatment, 69% of these women will have an adverse outcome of pregnancy. The objectives of this study were to review the literature systematically to determine the effectiveness of screening interventions to prevent congenital syphilis and other adverse pregnancy outcomes.
We searched four electronic databases and selected studies to examine evidence for effectiveness of interventions on three outcomes: increased uptake of syphilis testing, increased treatment rates, and reduction in adverse pregnancy outcomes. We used fixed effects meta-analysis to estimate pooled relative risks if no or little evidence of heterogeneity between trials existed.
Ten studies met the inclusion criteria, including two randomised trials. Only two studies aimed to encourage women to seek care earlier in pregnancy. Nine studies included decentralisation of screening and treatment. The effects of the interventions on uptake of testing for antenatal syphilis and receiving at least one dose of penicillin were variable and could not be combined statistically. Study interventions were associated with a reduction in perinatal death (pooled risk ratio [RR] from three studies 0·46, 95% CI 0·26-0·82) and stillbirth (pooled RR from three studies 0·42, 95% CI 0·19-0·93). The incidence of congenital syphilis was reduced in all four studies that measured this outcome with heterogeneous results.
Interventions to improve the coverage and effect of screening programmes for antenatal syphilis could reduce the syphilis-attributable incidence of stillbirth and perinatal death by 50%. The resources required to roll out antenatal screening programmes would be a worthwhile investment for reduction of adverse pregnancy outcomes and improvement of neonatal and child survival.
None.
每年约有 210 万孕妇患有活动性梅毒。如果不进行筛查和治疗，其中 69%的孕妇将出现妊娠不良结局。本研究的目的是系统回顾文献，以确定筛查干预措施预防先天性梅毒和其他不良妊娠结局的有效性。
我们检索了四个电子数据库，并选择了研究来检验干预措施在三个结局上的有效性证据：提高梅毒检测率、提高治疗率和减少不良妊娠结局。如果试验之间没有或几乎没有异质性，则使用固定效应荟萃分析来估计汇总相对风险。
符合纳入标准的研究有 10 项，包括两项随机试验。只有两项研究旨在鼓励孕妇在妊娠早期寻求医疗保健。9 项研究包括筛查和治疗的去中心化。干预措施对产前梅毒检测率和至少接受一剂青霉素治疗率的影响是可变的，无法进行统计学合并。研究干预措施与围产儿死亡（来自三项研究的汇总风险比 [RR]为 0.46，95%CI 0.26-0.82）和死产（来自三项研究的汇总 RR 为 0.42，95%CI 0.19-0.93）减少有关。所有四项测量该结局的研究均显示先天性梅毒发病率降低，但结果存在异质性。
改善产前梅毒筛查方案的覆盖率和效果的干预措施可以使梅毒相关死产和围产儿死亡的发生率降低 50%。为减少不良妊娠结局和改善新生儿及儿童生存而开展产前筛查方案所需的资源将是一项值得的投资。
没有资金来源。
