2018 - 2021年美国六个州梅毒感染孕妇的分娩结局
Birth Outcomes Among Women With Syphilis During Pregnancy in Six U.S. States, 2018-2021.
作者信息
Carlson Jeffrey M, Sancken Christina L, Nguyen Khue, Lewis Elizabeth L, Praag Aisha, Pulliam Kourtney, Willabus Teri', Bakwa Zacharie Eric, Longcore Nicole D, O'Callaghan Kevin P, Miele Kathryn, Fountain Alison, Tong Van T, Woodworth Kate R
机构信息
Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, and the Georgia Department of Public Health, Atlanta, Georgia; the G2S Corporation, Shavano Park, Texas; the Maricopa County Department of Public Health, Phoenix, Arizona; Chickasaw Nation Industries, Norman, Oklahoma; the New Jersey Department of Health, Trenton, New Jersey; the Washington State Department of Health, Tumwater, Washington; and the New York State Department of Health, Albany, New York.
出版信息
Obstet Gynecol. 2025 May 2;146(1):121-128. doi: 10.1097/AOG.0000000000005913.
OBJECTIVE
To describe the association between syphilis treatment status and adverse pregnancy and neonatal outcomes among pregnancies complicated by syphilis.
METHODS
Six jurisdictions that participated in SET-NET (Surveillance for Emerging Threats to Mothers and Babies Network) reported data on women with syphilis during pregnancy and outcomes that occurred during 2018-2021. Frequencies of adverse outcomes were reported by syphilis treatment status during pregnancy as defined by the 2021 Sexually Transmitted Infections Treatment Guidelines (inadequate, adequate, and no treatment). Adjusted risk ratios (aRRs) were modeled for each outcome comparing adequate treatment with no treatment and with inadequate treatment, controlling for the pregnant woman's age at infection, education level, insurance status, reported substance use, number of prenatal visits, and stage of syphilis.
RESULTS
As of June 7, 2024, 1,682 singleton pregnancies complicated by syphilis were reported, with more than half of pregnant women adequately treated for syphilis (57.6%). Pregnant women with no or inadequate treatment had higher relative frequencies of adverse outcomes (stillbirth, prematurity, low birth weight [LBW], and neonatal intensive care unit [NICU] admission) than those with adequate treatment. The aRRs for stillbirth (9.9% vs 1.4%, aRR 3.72, 95% CI, 1.73-8.03), LBW (30.1% vs 9.9%, aRR 1.51, 95% CI, 1.07-2.14), and NICU admission (66.7% vs 27.0%, aRR 1.60, 95% CI, 1.28-1.98) were higher in pregnant women with no treatment compared with those with adequate treatment. Inadequate treatment was associated with LBW and NICU admission (24.9% vs 9.9%, aRR 1.81, 95% CI, 1.29-2.52; and 57.2% vs 27.0%, aRR 1.61, 95% CI, 1.31-1.99, respectively) compared with adequate treatment.
CONCLUSION
The high relative frequencies of adverse pregnancy and neonatal outcomes associated with inadequately treated or untreated syphilis during pregnancy reinforce the importance of adequate treatment in mitigating the effects of syphilitic infection. Increased attention and systematic strategies are needed to address gaps in screening and treatment before and during pregnancy to reduce adverse pregnancy and neonatal outcomes.
目的
描述梅毒治疗状况与梅毒合并妊娠的不良妊娠及新生儿结局之间的关联。
方法
参与母婴新兴威胁监测网络（SET-NET）的六个辖区报告了2018 - 2021年期间梅毒孕妇的数据及相关结局。按照《2021年性传播感染治疗指南》定义的孕期梅毒治疗状况（治疗不充分、充分治疗和未治疗）报告不良结局的发生率。针对每个结局构建调整风险比（aRRs）模型，比较充分治疗与未治疗以及治疗不充分的情况，同时控制孕妇感染时的年龄、教育水平、保险状况、报告的物质使用情况、产前检查次数和梅毒分期。
结果
截至2024年6月7日，报告了1682例合并梅毒的单胎妊娠，超过半数的孕妇接受了充分的梅毒治疗（57.6%）。未治疗或治疗不充分的孕妇不良结局（死产、早产、低出生体重[LBW]和新生儿重症监护病房[NICU]收治）的相对发生率高于接受充分治疗的孕妇。与充分治疗的孕妇相比，未治疗孕妇的死产（9.9%对1.4%，aRR 3.72，95% CI，1.73 - 8.03）、低出生体重（30.1%对9.9%，aRR 1.51，95% CI，1.07 - 2.14）和NICU收治（66.7%对27.0%，aRR 1.60，95% CI，1.28 - 1.98）的aRRs更高。与充分治疗相比，治疗不充分与低出生体重和NICU收治相关（分别为24.9%对9.9%，aRR 1.81，95% CI，1.29 - 2.52；57.2%对27.0%，aRR 1.61，95% CI，1.31 - 1.99）。
结论
孕期梅毒治疗不充分或未治疗导致的不良妊娠和新生儿结局的高相对发生率，强化了充分治疗在减轻梅毒感染影响方面的重要性。需要更多关注并制定系统策略来解决孕前和孕期筛查及治疗方面的差距，以减少不良妊娠和新生儿结局。
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