Treatment status of maternal syphilis infection and factors associated with their adverse pregnant outcomes in Shanghai during 2013-2015

Abstract

Objective To analyze the factors associated with syphilis treatment compliance and adverse pregnant outcomes among pregnant women with syphilis in Shanghai. Methods The prospective cohort was established based on maternal syphilis monitoring system of Shanghai, which included all the pregnant women diagnosed with syphilis during Jan 2013 to Dec 2015. A total of 1 717 pregnant women with syphilis were recruited at the baseline, and 1 147 of them were followed up during treatment and their pregnancy, and the delivery outcomes were recorded. The information of testing/treatment of pregnant women with syphilis and health outcomes of infants were collected. Chi-square test was used for univariate analysis and logistic regression model was used to identify the factors associated with syphilis treatment and adverse pregnant outcomes. Results A total of 685 participants received syphilis treatment during pregnancy, with the treatment rate of 59.7%. Among them, 397(34.6%) patients underwent two courses of complete treatment. The poor educated, unemployed/job-waiting or multipara population had poor compliance to treatment. Only 34.9% (142/407) of cases diagnosed at last trimester received syphilis treatment and 10.1%(41/407) completed the treatment. The proportion of non-treponemal conversion were higher in subjects who received syphilis treatment during pregnancy than those who did not (39.1%[268/285] vs 3.7%[17/462]). Complete syphilis treatment during pregnancy was protective factor to decrease neonatal death adjusted relative risk ([aRR]=0.05, 95%CI: 0.01-0.37, P=0.003) and prematurity/low birth weight (aRR=0.44, 95%CI: 0.27-0.70, P=0.001). Strong positive non-treponemal result before delivery increased the risks of neonatal death (aRR=12.89, 95%CI: 1.70-100.43, P=0.014) and prematurity/low birth weight (aRR=12.78, 95%CI: 152-5.06, P=0.001). Conclusions Factors such as educational level, employment status, and maternal history will affect the compliance of syphilis treatment during pregnancy. Early diagnosis and complete treatment course of syphilis could improve the pregnant outcomes and the health status of infants. Key words: Syphilis; Mother-to-child transmission; Treatment; Adverse pregnant outcome