Dalmartello Michela, Parazzini Fabio, Pedron Mariangela, Pertile Riccardo, Collini Lucia, La Vecchia Carlo, Piffer Silvano
a Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy.
b Department of Obstetrics, Gynecology, and Neonatology , University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy.
J Matern Fetal Neonatal Med. 2019 Jun;32(12):2049-2055. doi: 10.1080/14767058.2018.1424822. Epub 2018 Jan 17.
Rubella, syphilis, toxoplasmosis, cytomegalovirus (CMV), hepatitis B (HBV) and C (HCV), HIV, and Group B Streptococcus (GBS) infections may have very severe outcomes during pregnancy, and for this reason, monitoring of infections in pregnant women is a requirement of prenatal assistance.
To describe coverage and outcome of the screening for rubella, syphilis, toxoplasmosis, CMV, HBV, HCV, HIV, and Group B Streptococcus in pregnancy in the Autonomous Province of Trento, Northern Italy (538,600 inhabitants).
We analysed the coverage and outcome of the above-mentioned screenings among women who delivered in the hospitals of the Province of Trento between 2007 and 2014 (N = 38,712). Screenings were grouped according to characteristics such as recommendation by national and local guidelines, scheduling of the tests, operating methods, and charge. We also estimated odds ratios (ORs) for missing screening for selected infections through multiple logistic regression.
Estimated uptake of antenatal screening was 99.7% for rubella, 99.3% for syphilis, 99.7% for toxoplasmosis, 98.1% for HIV infection, 99.0% for HBV, 98.9% for HCV, 94.0% for GBS infection, and 75.4% for CMV infection. The overall prevalence of immunity was 94.1% for rubella, 24.2% for toxoplasmosis, and 64.2% for CMV. The rate of seroconversion in pregnant women was 0.02% for rubella, 0.29% for toxoplasmosis, and 0.75% for CMV. The overall prevalence of infection was 0.94% for HBV, 0.53% for HCV, 22.3% for GBS, 0.29% for syphilis, and 0.13% for HIV. We found a significant positive association for all screening tests, between lack of testing and late first medical examination in pregnancy (ORs ranging from 1.20 to 1.66 for the first medical visit in the second trimester and ORs ranging from 1.60 to 5.88 for the first medical visit in third trimester, compared to early medical visit in the first trimester). Compared to Italian citizenship, foreign citizenship of the mother was also positively associated with absence of screening (ORs ranging from 1.30 to 1.53). A significant inverse association was observed for calendar year of delivery (ORs ranging from 0.71 to 0.97, for 1 year increment). Less educated mothers and pluriparae were also at higher risks of not being tested. Analysis of the association with mother age showed different heterogeneous effects.
Our study indicates that the attention to screening and detecting infected cases is growing over the time. In addition, care delivered during pregnancy has a leading role in determining coverage of the examinations. Immigrant, pluriparous and less educated women need particular attention.
风疹、梅毒、弓形虫病、巨细胞病毒（CMV）、乙型肝炎（HBV）和丙型肝炎（HCV）、HIV以及B族链球菌（GBS）感染在孕期可能会导致非常严重的后果，因此，监测孕妇感染情况是产前检查的一项要求。
描述意大利北部特伦托自治省（538,600名居民）孕期风疹、梅毒、弓形虫病、CMV、HBV、HCV、HIV以及B族链球菌筛查的覆盖率和结果。
我们分析了2007年至2014年间在特伦托省医院分娩的妇女（N = 38,712）中上述筛查的覆盖率和结果。筛查根据国家和地方指南的建议、检查时间安排、操作方法和收费等特征进行分组。我们还通过多因素逻辑回归估计了未进行某些感染筛查的比值比（OR）。
估计产前筛查的覆盖率为：风疹99.7%，梅毒99.3%，弓形虫病99.7%，HIV感染98.1%，HBV 99.0%，HCV 98.9%，GBS感染94.0%，CMV感染75.4%。总体免疫率为：风疹94.1%，弓形虫病24.2%，CMV 64.2%。孕妇血清转换率为：风疹0.02%，弓形虫病0.29%，CMV 0.75%。总体感染率为：HBV 0.94%，HCV 0.53%，GBS 22.3%，梅毒0.29%，HIV 0.13%。我们发现，对于所有筛查试验，未进行检测与孕期首次产检较晚之间存在显著正相关（与孕早期首次产检相比，孕中期首次产检的OR范围为1.20至1.66，孕晚期首次产检的OR范围为1.60至5.88）。与意大利公民身份相比，母亲的外国公民身份也与未进行筛查呈正相关（OR范围为1.30至1.53）。观察到分娩年份存在显著负相关（每年增加1年，OR范围为0.71至0.97）。受教育程度较低的母亲和经产妇未接受检测的风险也较高。对与母亲年龄的关联分析显示出不同的异质性影响。
我们的研究表明，随着时间的推移，对筛查和检测感染病例的关注度在不断提高。此外，孕期护理在决定检查覆盖率方面起着主导作用。移民、经产妇和受教育程度较低的妇女需要特别关注。
