Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5828-5833. doi: 10.1080/14767058.2021.1895740. Epub 2021 Mar 7.
Syphilis infections affect many pregnant women worldwide every year. The increasing rates of maternal and congenital syphilis infections in recent years in the United States necessitates further investigation into the adverse effects of syphilis infection on maternal and neonatal health.
We sought to examine the association of maternal syphilis infection with adverse pregnancy and perinatal outcomes.
We performed a retrospective cohort study of women with singleton pregnancies who delivered between 23 and 42 weeks in California between 2007 and 2011. We compared demographic characteristics and pregnancy outcomes between pregnant women with syphilis and without syphilis. Maternal outcomes of interest included gestational hypertension, pre-eclampsia, gestational diabetes, preterm delivery, cesarean delivery, induction of labor, and severe maternal morbidity. Neonatal outcomes included neonatal intensive care unit admission, congenital anomaly, congenital syphilis, small for gestational age, stillbirth, neonatal death, infant death. Descriptive statistics were assessed using chi-square/Fisher's Exact tests. Multivariable logistic regression was used to estimate the association between syphilis and adverse pregnancy and perinatal outcomes. Statistical comparisons with a -value of less than .05 and 95% CI that did not cross the null were considered statistically significant.
Among a cohort of 2,566,246 women, there were 991 pregnancies complicated by maternal infection with syphilis (0.04%). We found during multivariable logistic regression that syphilis infection was significantly associated with preterm delivery (aOR: 1.27, 95% CI: 1.05-1.54), NICU admission >24 h (aOR: 2.54, 95% CI: 2.13-3.04) and stillbirth (aOR: 5.01, 95% CI: 3.16-7.92) after adjusting for a number of potential confounders including maternal age, race/ethnicity, education, parity, prenatal visits, body mass index, smoking and insurance status.
Maternal syphilis infection in pregnancy is associated with specific adverse pregnancy outcomes, even after adjusting for potential confounders. These data can be used to counsel patients with syphilis in pregnancy, and in developing approaches to clinical care. Due to the increased risk of stillbirth, perhaps such patients should receive antenatal testing. Further research is necessary to investigate the mechanisms of morbidity.
梅毒感染每年都会影响全球许多孕妇。近年来，美国的母婴梅毒感染率不断上升，这就需要进一步研究梅毒感染对母婴健康的不良影响。
我们旨在研究母体梅毒感染与不良妊娠和围产儿结局的关系。
我们对 2007 年至 2011 年间加利福尼亚州 23 至 42 周单胎妊娠分娩的妇女进行了回顾性队列研究。我们比较了患有梅毒和未患有梅毒的孕妇的人口统计学特征和妊娠结局。感兴趣的母体结局包括妊娠期高血压、子痫前期、妊娠期糖尿病、早产、剖宫产、引产和严重产妇发病率。新生儿结局包括新生儿重症监护病房（NICU）入住、先天性异常、先天性梅毒、小于胎龄儿、死胎、新生儿死亡、婴儿死亡。采用卡方/Fisher 精确检验评估描述性统计数据。采用多变量逻辑回归估计梅毒与不良妊娠和围产儿结局之间的关系。统计学意义的评估标准为 - 值小于.05 且 95%置信区间不跨越零界值。
在 2566246 名妇女的队列中，有 991 例妊娠合并母体梅毒感染（0.04%）。我们通过多变量逻辑回归发现，梅毒感染与早产（aOR：1.27，95%CI：1.05-1.54）、NICU 入住>24 小时（aOR：2.54，95%CI：2.13-3.04）和死产（aOR：5.01，95%CI：3.16-7.92）显著相关，在调整了母亲年龄、种族/民族、教育程度、产次、产前检查次数、体重指数、吸烟状况和保险状况等多种潜在混杂因素后，结果仍然具有统计学意义。
即使在调整了潜在混杂因素后，妊娠期间母体梅毒感染与特定的不良妊娠结局相关。这些数据可用于对妊娠合并梅毒的患者进行咨询，并为临床护理方法的制定提供依据。由于死产风险增加，此类患者或许应接受产前检查。还需要进一步的研究来探讨发病率的机制。
