Paixão Enny S, Carroll Orlagh, Rodrigues Laura C, de Oliveira Guilherme Lopes, Cardoso Andrey Moreira, de Cássia Ribeiro-Silva Rita, Barreto Mauricio L, Ichihara Maria Yury
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil.
JAMA Netw Open. 2025 Apr 1;8(4):e257471. doi: 10.1001/jamanetworkopen.2025.7471.
While the short-term impacts of congenital syphilis are well documented, the long-term outcomes and effects on children exposed to syphilis during pregnancy but without congenital infection detected at birth remain unclear.
To compare the rates of all-cause hospitalization in children younger than 5 years between those exposed to syphilis during pregnancy (with and without congenital syphilis) and those unexposed to syphilis during pregnancy.
DESIGN, SETTING, AND PARTICIPANTS: Population-based study using linked data from the Center of Data and Knowledge Integration for Health Birth Cohort, including singleton live births between January 1, 2011, and December 31, 2015. Children were followed up until age 5 years, death, or December 31, 2018, whichever occurred first. Data were made available in 2020 and analyzed between March and September 2024.
In this study, syphilis during pregnancy was categorized into 3 groups: (1) maternal syphilis, (2) congenital syphilis, and (3) no exposure, for those without syphilis records.
Primary outcomes were: (1) general and age-stratified first hospital admission rates, (2) length of stay for the first hospital admission, and (3) International Classification of Diseases and Related Health Problems, Tenth Revision diagnoses of the first hospitalization. Secondary outcomes included: (1) recurrent hospital admissions and (2) mortality.
The study included 8 286 867 singleton births, with 30 039 exposed to maternal syphilis (15 482 [51.5%] male, 7642 [25.4%] Asian, 2442 [8.1%] Black, and 16 930 [56.4%] Pardo [denotes individuals who are White and Indigenous, White and Black, Black and Indigenous, or Black and another race]) and 36 443 with congenital syphilis (18 286 [50.2%] male, 6977 [19.1%] Asian, 3769 [10.3%] Black, 16 930 [56.4%] Pardo). Exposed births were more prevalent in Black, single, and less educated women. Compared with children with no exposure, those with congenital syphilis had an increased risk of first hospitalization (hazard ratio [HR], 6.19; 95% CI, 6.11-6.28), as did those exposed to maternal syphilis (HR, 1.90; 95% CI, 1.86-1.94). The highest risk of first hospitalization was observed in the first month of life, among those with congenital syphilis (HR, 11.53; 95% CI, 11.36-11.70). Although the risk decreased with age, children exposed to syphilis continued to have higher hospitalization rates than the nonexposed group until the age of 36 months. Live-born children exposed to syphilis during pregnancy also had more and longer hospital admissions. Those with congenital syphilis had a lower prevalence of respiratory and digestive diagnoses than those with maternal syphilis and the nonexposed group.
In this cohort study, we observed that those children exposed to syphilis during pregnancy, even without congenital syphilis detected at birth, had a higher risk of hospital admission and were hospitalized for longer periods. These findings underscore the need for close monitoring of exposed children and emphasize the importance of preventing syphilis in women of childbearing age.
虽然先天性梅毒的短期影响已有充分记录，但对于孕期接触梅毒但出生时未检测出先天性感染的儿童的长期结局和影响仍不清楚。
比较孕期接触梅毒（有或无先天性梅毒）的5岁以下儿童与孕期未接触梅毒的儿童的全因住院率。
设计、背景和参与者：基于人群的研究，使用来自健康出生队列数据与知识整合中心的关联数据，包括2011年1月1日至2015年12月31日期间的单胎活产。对儿童进行随访至5岁、死亡或2018年12月31日，以先发生者为准。数据于2020年提供，并于2024年3月至9月进行分析。
在本研究中，孕期梅毒分为3组：（1）母亲梅毒，（2）先天性梅毒，（3）未接触（无梅毒记录者）。
主要结局为：（1）总体和按年龄分层的首次住院率，（2）首次住院的住院时间，（3）首次住院的国际疾病分类及相关健康问题第十次修订版诊断。次要结局包括：（1）再次住院和（2）死亡率。
该研究纳入8286867例单胎出生，其中30039例接触母亲梅毒（15482例[51.5%]为男性，7642例[25.4%]为亚洲人，2442例[8.1%]为黑人（非裔），16930例[56.4%]为帕尔多（指白人及原住民、白人及黑人、黑人及原住民或黑人及其他种族的个体）），36443例患有先天性梅毒（18286例[50.2%]为男性，6977例[19.1%]为亚洲人，3769例[10.3%]为黑人（非裔），16930例[56.4%]为帕尔多）。接触梅毒的出生在黑人、单身和受教育程度较低的女性中更为普遍。与未接触梅毒的儿童相比，患有先天性梅毒的儿童首次住院风险增加（风险比[HR]，6.19；95%置信区间[CI]，6.11 - 6.28），接触母亲梅毒的儿童也是如此（HR，1.90；95% CI，1.86 - 1.94）。首次住院风险最高的是出生后第一个月内患有先天性梅毒的儿童（HR，11.53；95% CI，11.36 - 11.70）。虽然风险随年龄降低，但接触梅毒的儿童在36个月龄前的住院率仍高于未接触组。孕期接触梅毒的活产儿童住院次数也更多且住院时间更长。患有先天性梅毒的儿童呼吸道和消化系统诊断的患病率低于患有母亲梅毒的儿童和未接触组。
在这项队列研究中，我们观察到孕期接触梅毒的儿童，即使出生时未检测出先天性梅毒，住院风险也更高且住院时间更长。这些发现强调了对接触梅毒儿童进行密切监测的必要性，并强调了预防育龄妇女梅毒的重要性。
