Influencing factors for mother to child transmission of syphilis in pregnancy in Guangdong
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摘要:
目的 分析广东省梅毒感染孕产妇的特征及其母婴传播影响因素,为广东省消除母婴传播政策制定提供依据。 方法 以2014年1月1日至2021年2月1日广东省发生胎传梅毒的感染孕产妇为病例组,另以同地区、同分娩年度为匹配条件,筛选出未发生胎传梅毒的梅毒感染孕妇为对照组。 对相关危险因素进行单因素和多因素条件logistic回归分析。 结果 多因素条件logistic回归分析显示,同≤20岁年龄组的孕产妇相比,21~25岁(OR=0.537,95%CI:0.341~0.845)、26~30岁(OR=0.43,95%CI:0.272~0.679)、31~35岁(OR=0.322,95%CI:0.202~0.512)和≥36岁者(OR=0.321,95%CI:0.194~0.532)发生母婴传播的风险均较低;既往未发现患梅毒的孕产妇发生母婴传播的风险较高(OR=1.837,95%CI:1.352~2.495);同在孕期就已经诊断患病的孕产妇相比,产时和产后诊断患梅毒的孕产妇发生梅毒母婴传播的风险均较高(OR=2.026,95%CI:1.472~2.790)、(OR=1.951,95%CI:1.333~2.856);同孕早期进行治疗的孕产妇相比,孕中期和孕晚期进行治疗孕产妇发生母婴传播的风险较高(OR=3.712,95%CI:1.977~6.970)、(OR=11.531,95%CI:6.363~20.894)。 结论 在消除梅毒母婴传播的工作中需加强对低龄孕产妇梅毒等性病防治的健康教育,提高梅毒防病知识。 妊娠合并梅毒早发现、早诊断、早治疗是降低梅毒母婴传播的关键,通过早期梅毒筛查、诊断和治疗能够有效的降低梅毒母婴传播发生的风险。 Abstract:Objective To analyze the characteristics of pregnant women infected with syphilis and the influencing factors of mother to child transmission in Guangdong province, and provide evidence for the development of policies form the elimination of the mother to child transmission. Methods Infected pregnant women who developed fetal transmitted syphilis from January 1, 2014 to February 1, 2021 in Guangdong Province were selected as the case group, and another pregnant women with syphilis infection who did not develop fetal transmitted syphilis were screened as the control group using the same region and year of delivery as matching conditions. Results Multivariate conditional logistic regression analysis showed that compared with pregnant women aged ≤20 years, the risk for mother to child transmission of syphilis was lower in those aged 21−25 years (OR=0.537, 95% CI: 0.341−0.845), 26−30 years (OR=0.43, 95% CI: 0.272−0.679), 31−35 years (OR=0.322, 95% CI: 0.202−0.512) and ≥36 years (OR=0.321, 95% CI: 0.194−0.532); The risk for the mother to child transmission in pregnant women with non-diagnosed syphilis was higher (OR=1.837, 95% CI: 1.352−2.495); Compared with the pregnant women who were diagnosed with syphilis during pregnancy, the pregnant women who were diagnosed with syphilis during labor and after delivery had higher risk of mother to child transmission of syphilis (OR=2.026, 95% CI: 1.472−2.790), (OR=1.951, 95% CI: 1.333−2.856). Compared with the pregnant women receiving treatment in the first trimester, the pregnant women receiving treatment in the second and third trimesters had higher risk of mother to child transmission of syphilis (OR=3.712, 95% CI: 1.977−6.970), (OR=11.531, 95% CI: 6.363−20.894). Conclusion In the elimination of mother to child transmission of syphilis, it is necessary to strengthen the health education about the prevention and treatment of sexually transmitted diseases, such as syphilis, in young pregnant women, and improve their awareness of syphilis prevention. Early detection, diagnosis and treatment of syphilis in pregnancy are essential to reduce mother to child transmission of syphilis. Early screening, diagnosis and treatment of syphilis can effectively reduce the risk of mother to child transmission of syphilis -
表 1 梅毒感染孕产妇母婴传播影响因素的单因素分析
Table 1. Univariate analysis on influencing factors for mother to child transmission of syphilis in pregnant women
类别 特征 病例组(例) 对照组(例) χ2值 P值 人口学特征 年龄组(岁) 54.591 <0.01 0~ 59 79 21~ 109 367 26~ 104 429 31~ 73 422 36~ 51 287 民族 0.000 1.000 汉族 370 1 480 其他 26 104 婚姻状态 26.155 <0.01 在婚 313 1 408 不在婚 83 176 教育程度 1.705 0.426 小学及以下 75 317 初中/高中 302 1 163 大学及以上 19 104 职业 3.889 0.143 农民/牧民/渔民 74 334 家务及待业 245 892 其他 77 358 孕产史 产次 0.072 0.789 初产妇 115 468 经产妇 281 1 116 梅毒感染孕产妇诊断与治疗情况 既往诊断感染 42.527 <0.01 是 79 594 否 317 990 梅毒感染途径 0.237 0.888 性传播 158 640 其他途径 5 24 不详 233 920 本次诊断梅毒时期 51.764 <0.001 孕期 197 1 093 产时 130 314 产后 69 177 本次诊断梅毒分期 31.444 <0.01 隐性 269 1 267 Ⅰ期 23 67 Ⅱ/Ⅲ期 2 17 不详 102 233 孕产妇药物治疗的时期 112.482 <0.001 孕早期 13 358 孕中期 62 413 孕晚期 167 323 孕前 2 12 其他 152 478 治疗药物 112.482 <0.001 青霉素治疗 275 1 203 其他药物治疗 16 46 不用药 105 335 梅毒感染孕产妇分娩情况 分娩方式 2.751 0.253 阴道产 243 918 剖宫产 130 540 不详 23 126 出现孕产期异常情况 4.577 0.714 是 64 192 否 332 1 392 发生胎膜早破 0.010 0.919 是 21 62 否 375 1 502 发生产后出血 是 4 14 0.057 0.811 否 392 1 570 新生儿基本特征及治疗情况 新生儿性别 0.437 0.509 男性 209 863 女性 187 721 新生儿身长(cm) 109.213 <0.01 ≤45 87 64 >45 309 1 520 新生儿体重(g) 125.739 <0.01 ≤2500 129 138 >2500 267 1 446 新生儿 接受预防性治疗 0.173 0.677 是 260 1 057 否 136 527 表 2 梅毒母婴传播多因素logistic回归分析
Table 2. Multivariate Logistic regression analysis on influencing factors for mother to child transmission of syphilis
影响因素 β $s_{\bar x}$ χ2值 P值 OR值(95%CI) 年龄组(岁) 0~ 1.000 21~ −0.623 0.231 7.236 <0.01 0.537(0.341~0.845) 26~ −0.845 0.233 13.132 <0.01 0.430(0.272~0.679) 31~ −1.134 0.237 22.881 <0.01 0.322(0.202~0.512) 36~ −1.135 0.257 19.486 <0.01 0.321(0.194~0.532) 既往诊断感染 是 1.000 否 0.608 0.156 15.129 <0.01 1.837(1.352~2.495) 本次诊断时期 孕期 1.000 产时 0.706 0.163 18.726 <0.01 2.026(1.472~2.790) 产后 0.668 0.194 11.819 <0.01 1.951(1.333~2.856) 孕产妇药物治疗时期 孕早期 1.000 孕中期 1.311 0.321 16.643 <0.01 3.712(1.977~6.970) 孕晚期 2.445 0.303 64.986 <0.01 11.531(6.363~20.894) 其他 1.575 0.314 25.177 <0.01 4.829(2.610~8.932) -
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