Synthesized prevention and control of one decade for mother-to-child transmission of syphilis and determinants associated with congenital syphilis and adverse pregnancy outcomes in Shenzhen, South China

摘要

The purpose of this investigation was to assess the effectiveness of an intervention program on mother-to-child transmission (MTCT) of syphilis and investigate determinants of congenital syphilis (CS) and adverse pregnancy outcomes (APOs). The Shenzhen local government initiated an intervention program of MTCT of syphilis in 2001. Based on this program, maternal and paternal factors associated with CS and APOs among syphilitic women were investigated from 2007 to 2012 by a prospective cohort study. From 2002 to 2012, 2,441,237 pregnant women were screened and screening coverage reached 97.2 % in 2012. In the background of continuing growth of CS in China, CS in Shenzhen significantly decreased from 109.3 cases in 2002 to 9.9 cases in 2012 per 100,000 live births. Maternal education (adjusted odds ratio [aOR](CS) = 0.65; aOR(APOs) = 0.79) and history of syphilis (aOR(CS) = 0.28; aOR(APOs) = 0.61), as well as paternal age (aOR(CS) = 0.62; aOR(APOs) = 0.86) and education (aOR(CS) = 0.66; aOR(APOs) = 0.86) were negatively associated with CS and APOs, but maternal unmarried status (aOR(CS) = 1.95; aOR(APOs) = 2.61), inadequate antenatal care (ANC) (aOR(CS) = 3.61; aOR(APOs) = 1.79), more sexual partners (aOR(CS) = 1.51; aOR(APOs) = 1.39), every week of delay in treatment (aOR(CS) = 2.82; aOR(APOs) = 1.27), higher baseline titers of nontreponemal antibodies (aOR(CS) = 5.65; aOR(APOs) = 1.47), early syphilis (aOR(CS) = 23.24; aOR(APOs) = 26.95), and non-penicillin treatment (aOR(CS) = 3.00; aOR(APOs) = 2.16), as well as paternal history of cocaine use (aOR(CS) = 2.70; aOR(APOs) = 2.44) and positive (aOR(CS) = 4.14; aOR(APOs) = 1.50) or unknown (aOR(CS) = 2.37; aOR(APOs) = 2.06) status of syphilis increased the risk of CS and APOs. Condom use (aOR = 0.70) decreased MTCT of syphilis. A ten-year program consisting of screening and treatment, early ANC, health education, partners tracking, detection, and treatment, follow-up visits, and information management is an effective means to block MTCT of syphilis. Maternal and paternal factors constituted two separate profiles associated with MTCT of syphilis.