湖南省2013-2018年梅毒感染孕产妇不良妊娠结局的风险因素

Risk factors of adverse pregnancy outcomes in syphilis-infected pregnant women in Hunan province from 2013 to 2018

目的了解湖南省梅毒感染孕产妇妊娠结局情况,分析影响发生不良妊娠结局的因素。方法将2013年1月1日至2018年12月31日湖南省预防艾滋病、梅毒和乙肝母婴传播信息管理系统中有妊娠结局的梅毒感染孕产妇纳入研究对象,收集其人口学特征、孕产期保健和梅毒治疗情况等信息。根据梅毒感染孕产妇的妊娠结局,分为正常妊娠组和不良妊娠结局组,采用多因素Logistic回归控制混杂因素,分析梅毒感染孕产妇发生不良妊娠结局的影响因素。结果14219例梅毒阳性孕妇中,有明确妊娠结局且为单胎的有11346例,不良妊娠结局的发生率为19.1%(2166例),其中自然流产的占2.0%(222例),死胎或死产的占1.2%(133例),7天内死亡的占0.7%(75例),早产或低出生体重占10.8%(1221例),新生儿窒息占1.1%(121例),新生儿肺炎占0.8%(87例),发生出生缺陷占1.4%(161例),先天梅毒儿占1.3%(146例)。与不良妊娠结局有关的危险因素有梅毒感染孕产妇年龄<20岁[调整比值比(aOR)=1.247,95%可信区间(CI):1.088~1.493]、≥35岁(aOR=1.402,95%CI:1.167~1.686)、不在婚(aOR=1.855,95%CI:1.453~2.367)、初检孕周在孕晚期(aOR=1.266,95%CI:1.032~1.555)、确诊感染梅毒在孕晚期(aOR=5.806,95%CI:1.796~18.770)、产时(aOR=4.102,95%CI:1.263~13.330)、丈夫/性伴感染梅毒(aOR=1.222,95%CI:1.068~1.398)、不规范用药(aOR=6.756,95%CI:5.586~8.197)、未用药(aOR=3.300,95%CI:2.841~3.846)。结论2013-2018年湖南省梅毒感染孕产妇不良妊娠结局发生率较高,提高孕产妇的梅毒孕早中期检测率,加强梅毒感染孕产妇的规范治疗率和对丈夫/性伴的检测和治疗,可以减少梅毒感染孕产妇的不良妊娠结局。

Objective To understand the pregnancy outcome of syphilis-infected pregnant women in Hunan province by analyzing the factors affecting the adverse pregnancy outcome.Methods A retrospective analysis was conducted based on the data of the maternal and child transmission from the national IPMTCT information management system during January 1,2013 and December 31,2018.According to the pregnancy outcomes,the syphilis-infected pregnant women were divided into two groups with one as the normal and another with the adverse pregnancy outcomes.Multivariate logistic regression was used to control the confuser factors,and the factors influencing the adverse pregnancy outcomes were analyzed.Results Among the 14219 cases of syphilis-infected pregnant women,the incidence of total adverse pregnancy outcomes was 19.1%(2166/11346),including 2.0%(222/11346)of spontaneous abortion,1.2%(133/11346)of stillbirth incidence,0.7%(75/11346)of the death within 7 days,10.8%(1221/11346)of the preterm labor or low birth weight,and 1.1%(121/11346)of neonatal asphyxia,0.8%(87/11346)of neonatal pneumonia,1.4%(161/11346)of birth defects,and 1.3%(146/11346)of congenital syphilis.The risk factors associated with adverse pregnancy outcomes were the age of pregnant women with syphilis infection<20 years old(aOR=1.274,95%CI:1.088-1.493),≥35 years old(aOR=1.402,95%CI:1.167-1.686),unmarried(aOR=1.855,95%CI:1.453-2.367),the first week of pregnancy in the third trimester(aOR=1.266,95%CI:1.032-1.555),and the syphilis diagnosed in the third trimester(aOR=5.806,95%CI:1.796-18.770),at birth(aOR=4.102,95%CI:1.263-13.330),husband/sexual partners infected with syphilis(aOR=1.222,95%CI:1.068-1.398),nonstandard medication(aOR=6.756,95%CI:5.586-8.197),and non-medication(aOR=3.300,95%CI:2.841-3.846).Conclusion From 2013 to 2018,the incidence of adverse pregnancy outcomes in pregnant women infected with syphilis is relatively high in Hunan.To reduce the adverse pregnancy outcomes,we should improve the early and mid-stage detection of syphilis pregnancy,strengthen the standardized treatment of pregnant women infected with syphilis and the detection and treatment of their husbands and sexual partners.