2012—2021年湖北省梅毒感染孕产妇不良妊娠结局及影响因素分析

Analysis of adverse pregnancy outcomes and influencing factors in syphilis-infected pregnant women in Hubei Province from 2012 to 2021

目的了解湖北省梅毒感染孕产妇发生不良妊娠结局(adverse pregnancy outcomes,APOS)的状况及影响因素。方法收集2012年1月1日—2021年12月31日湖北省预防梅毒母婴传播管理信息系统报告的已分娩的梅毒感染孕产妇相关流行病学调查资料,采用χ^(2)检验和非条件logistic回归模型,分析梅毒感染孕产妇发生APOS状况及其影响因素。结果梅毒感染孕产妇4859例,年龄(29.59±5.50)岁,文化程度以初中及以下学历为主,3092例(63.64%),职业以家务及待业者为主,3312例(68.16%)。湖北省梅毒感染孕产妇APOS发生率21.24%(1032/4859),2012—2021年,APOS发生率呈逐年下降趋势(χ^(2)_(趋势)=10.48,P=0.001)。鄂东部地区梅毒感染孕产妇APOS的发生率为23.56%,高于鄂中部(19.68%)和鄂西部地区(19.57%),差异有统计学意义(χ^(2)=11.02,P=0.004)。多因素logistic分析显示,年龄15~<20岁(OR=1.61,95%CI:1.07~2.44)、年龄35~53岁(OR=1.24,95%CI:1.04~1.49)、不在婚(OR=1.48,95%CI:1.10~1.97)、孕期未治疗(OR=1.77,95%CI:1.49~2.09)、孕晚期开始治疗(OR=1.30,95%CI:1.09~1.55)、本次确诊时非梅试验滴度≥1∶8(OR=1.41,95%CI:1.20~1.66)和检测结果不详(OR=1.91,95%CI:1.29~2.84)均是梅毒感染孕产妇发生APOS的危险因素(P<0.05)。结论湖北省梅毒感染孕产妇APOS发生率逐年下降并存在明显的地域差别,影响APOS发生率的因素涉及年龄、婚姻状况、确诊时非梅血清学滴度和驱梅治疗等方面,准确识别危险因素,为孕产妇提供科学合理的健康教育和开展个性化干预措施是降低APOS发生风险的重要手段。

Objective To analyze the status of adverse pregnancy outcomes(APOS)in syphilis-infected pregnant women in Hubei Province and analyze the factors influencing APOS.MethodssEpidemiological investigation data of syphilis-infected pregnant women who have given birth reported in the Prevention of mother-to-child transmission of Syphilis Management Information System in Hubei Province from January 1,2012,to December 31,2021,were collected.Univariate Chi-square test and unconditional logistic regression model were used to analyze the occurrence of APOS in syphilis-infected pregnant women and its influencing factors.Results A total of 4859 syphilis-infected pregnant women were reported in Hubei,with an average age of(29.59±5.50)years.The education level was mainly junior high school education or below(63.64%,3092),and the occupations were mainly housework and unemployed(68.16%,3312).The incidence of APOS in syphilis-infected pregnant women in Hubei Province was 21.24%(1032/4859),showing a descending trend year by year(χ^(2)_(trend)=10.48,P=0.001).The incidence of APOS was 23.56%in eastern Hubei Province,higher than 19.68%in central Hubei Province and 19.57%in western Hubei Province(χ^(2)=11.02,P=0.004).The results of the multivariate analysis showed that factors such as age(15-<20 years)(OR=1.61,95%CI:1.07-2.44),age(35-53 years)(OR=1.24,95%CI:1.04-1.49),unmarried status(OR=1.48,95%CI:1.10-1.97),untreated during pregnancy(OR=1.77,95%CI:1.49-2.09),late start of treatment during pregnancy(OR=1.30,95%CI:1.09-1.55),non-treponemal test titer≥1:8 at diagnosis(OR=1.41,95%CI:1.20-1.66),and unknown test results(OR=1.91,95%CI:1.29-2.84)were all risk factors for APOS in syphilis-infected pregnant women(P<O.05).Conclusionss The incidence of APOS in syphilis-infected pregnant women in Hubei Province has been decreasing year by year,and there are significant regional differences.Factors affecting the APOS rate involve age,marriage status,non-treponemal serological titer at diagnosis,and syphilis treatment during pregnancy.Accurately identifying risk factors,providing scientific and reasonable health education for pregnant women,and implementing personalized intervention measures are important ways to reduce the risk of APOS.