California Department of Public Health, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Richmond, California, USA.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.
Am J Addict. 2022 May;31(3):210-218. doi: 10.1111/ajad.13265. Epub 2022 Mar 27.
Congenital syphilis (CS) is increasing in the United States and is associated with intersecting social and structural determinants of health. This study aimed to delineate birthing parent characteristics associated with CS in an adjusted model. METHODS (N = 720): People diagnosed with syphilis during pregnancy from 2017 to 2018 who were interviewed and linked to infants in the California state surveillance system were included (herein, "birthing parents"). Sociodemographic and clinical CS risk factors informed a stepwise multivariable logistic regression model in which the outcome of interest was infants born with CS. CS prevention continuums delineated the proportion of pregnant people with syphilis who completed steps (e.g., prenatal care entry, syphilis testing, treatment) needed to prevent CS; the outcome was delivering an infant without CS. We stratified continuums by homelessness and methamphetamine use to explore differences in CS outcomes.
Of 720 birthing parents, 245 (34%) delivered an infant with CS. Although CS was initially associated with homelessness (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.6, 4.0) and methamphetamine use (OR = 2.1, 95% CI: 1.4, 3.1), the addition of prenatal care into a final adjusted model attenuated these associations to not significant. In CS prevention continuums, delivering an infant without CS was less likely for people who reported methamphetamine use (p < .001) and/or homelessness (p < .001). However, when examining only those who received prenatal care, statistical differences for these predictors no longer existed. In the final adjusted model the following were associated with CS: no prenatal care (OR = 16.7, 95% CI: 9.2, 30.3) or late prenatal care (OR = 2.9, 95% CI: 1.9, 4.2); early stage of syphilis (OR = 2.6, 95% CI: 1.8, 3.7); living in Central California (OR = 2.1, 95% CI: 1.1, 4.2).
This is the first analysis to explore birthing parent characteristics associated with delivering an infant with CS in an adjusted model. We demonstrate that prenatal care, when accessed, can result in effective CS prevention among people who are unhoused and/or using methamphetamine equally well compared to counterparts without these risk factors.
先天性梅毒（CS）在美国呈上升趋势，与健康的交叉社会和结构性决定因素有关。本研究旨在在调整后的模型中描绘与 CS 相关的分娩父母特征。
方法（N=720）：从 2017 年至 2018 年期间，在加利福尼亚州监测系统中接受采访并与婴儿联系的患有梅毒的孕妇均被纳入研究（以下简称“分娩父母”）。社会人口统计学和临床 CS 风险因素告知了逐步多变量逻辑回归模型，其目的是研究与 CS 相关的婴儿。CS 预防连续描绘了接受梅毒检测并接受治疗的孕妇比例，以预防 CS；结果是分娩没有 CS 的婴儿。我们按无家可归和使用冰毒对连续体进行分层，以探讨 CS 结果的差异。
在 720 名分娩父母中，有 245 名（34%）分娩了患有 CS 的婴儿。尽管 CS 最初与无家可归（比值比[OR] = 2.5，95%置信区间[CI]：1.6，4.0）和使用冰毒有关（OR = 2.1，95% CI：1.4，3.1），但在最终调整后的模型中，将产前护理纳入后，这些关联变得不显著。在 CS 预防连续体中，报告使用冰毒（p < .001）和/或无家可归（p < .001）的人更不可能分娩没有 CS 的婴儿。然而，当仅检查接受产前护理的人时，这些预测因素不再存在统计学差异。在最终调整后的模型中，以下因素与 CS 相关：未接受产前护理（OR = 16.7，95% CI：9.2，30.3）或晚期产前护理（OR = 2.9，95% CI：1.9，4.2）；梅毒早期阶段（OR = 2.6，95% CI：1.8，3.7）；居住在加利福尼亚州中部（OR = 2.1，95% CI：1.1，4.2）。
这是第一项探索调整后的模型中与分娩父母相关的特征与分娩 CS 婴儿相关的分析。我们证明，与没有这些风险因素的对照相比，当获得产前护理时，产前护理可以在无家可归和/或使用冰毒的人群中同样有效地预防 CS。
