California Department of Public Health, Richmond, CA.
Sex Transm Dis. 2018 Jul;45(7):435-441. doi: 10.1097/OLQ.0000000000000782.
Congenital syphilis (CS), the transmission of Treponema pallidum from mother to fetus during pregnancy, can cause adverse birth outcomes. In 2012 to 2014, the CS rate in California increased more than 200% from 6.6 to 20.3 cases per 100,000 live births. Our objectives were to identify characteristics associated with delivering an infant with CS and missed opportunities for prevention among syphilis-infected pregnant women in California.
We linked California Department of Public Health syphilis surveillance records from women aged 15 to 45 years-diagnosed from March 13, 2012, to December 31, 2014-to birth records. We compared characteristics among mothers who delivered an infant with CS (CS mothers) with mothers who delivered an infant without CS (non-CS mothers) by using χ or Fisher exact tests. To visualize gaps in prevention among syphilis-infected pregnant women, we constructed a CS prevention cascade, a figure that shows steps to prevent CS.
During the selected period, 2498 women were diagnosed as having syphilis, and 427 (17%) linked to birth records; 164 (38%) were defined as CS mothers and 263 (62%) as non-CS mothers. Mothers with CS were more likely than non-CS mothers to have their first prenatal care visit in the third trimester. High proportions of mothers in both groups reported high-risk sexual behaviors, methamphetamine use, or incarceration (13%-29%). The CS prevention cascade showed decrements of 5% to 11% in prenatal care receipt, testing, and treatment steps; only 62% of potential CS births were prevented.
Multifaceted efforts are needed to address gaps in the CS prevention cascade and reduce CS cases in California.
先天性梅毒（CS）是梅毒螺旋体在妊娠期间由母亲传播给胎儿的一种疾病，可导致不良的出生结局。2012 年至 2014 年，加利福尼亚州 CS 发病率从每 10 万活产儿 6.6 例增加到 20.3 例，增幅超过 200%。我们的目的是确定与加利福尼亚州感染梅毒的孕妇分娩 CS 婴儿相关的特征，以及在这些孕妇中预防 CS 方面存在的错失机会。
我们将加利福尼亚州公共卫生部 2012 年 3 月 13 日至 2014 年 12 月 31 日期间年龄在 15 至 45 岁之间被诊断为梅毒的女性的疾病监测记录与出生记录进行了链接。我们使用 χ 或 Fisher 确切检验比较了分娩 CS 婴儿（CS 母亲）与分娩非 CS 婴儿（非 CS 母亲）的母亲之间的特征。为了直观地显示感染梅毒的孕妇在预防 CS 方面存在的差距，我们构建了 CS 预防级联图，这是一个显示预防 CS 步骤的图形。
在选定期间，有 2498 名女性被诊断为患有梅毒，其中有 427 名（17%）与出生记录相关联；164 名（38%）被定义为 CS 母亲，263 名（62%）为非 CS 母亲。与非 CS 母亲相比，CS 母亲更有可能在妊娠晚期首次进行产前保健。两组中均有相当比例的母亲报告存在高危性行为、使用安非他命或被监禁（13%-29%）。CS 预防级联图显示，产前保健、检测和治疗步骤的接受率分别下降了 5%-11%；仅有 62%的潜在 CS 分娩得到了预防。
需要采取多方面的努力来解决 CS 预防级联图中的差距，减少加利福尼亚州 CS 病例。
