Adverse pregnancy outcomes and influencing factors in pregnant women suffered from syphilis in Guangdong, 2015−2020
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摘要:
目的 分析广东省梅毒感染孕产妇的感染特征和不良妊娠结局的影响因素,为制定降低不良妊娠结局发生的政策提供依据。 方法 从“全国预防艾滋病、梅毒和乙肝母婴传播信息管理系统”中收集2015—2020年广东省梅毒感染孕产妇及所生新生儿的相关信息,对梅毒感染孕产妇不良妊娠结局的相关危险因素进行χ2检验和多因素logistic回归分析。 结果 不同年龄段、文化程度、婚姻状态、既往诊断情况、本次诊断时期、本次诊断梅毒分期、治疗情况、初次治疗时期发生不良妊娠的差异有统计学意义(P<0.05);多因素logistic回归分析显示,年龄≤20岁、文化程度小学及以下者发生不良妊娠的风险较大;既往未诊断梅毒者发生不良妊娠的风险较大(OR=1.350,95%CI:1.202~1.517);产时、产后诊断感染者较孕期诊断者发生不良妊娠的风险大;不在婚者较在婚者发生不良妊娠的风险大(OR=1.280,95%CI:1.027~1.420);本次诊断为Ⅱ、 Ⅲ期梅毒者较隐性梅毒者发生不良妊娠的风险大(OR=1.882,95%CI:1.039~3.195);未进行治疗者不良妊娠发生的风险较大(OR=3.465,95%CI:2.508~4.786);孕晚期再治疗者较孕早期治疗者发生不良妊娠的风险大(OR=2.245,95%CI=1.850~2.724)。 结论 年龄、文化程度、婚姻状况、诊断与治疗时期是梅毒感染孕产妇发生不良妊娠结局的影响因素。早期筛查、诊断并及时进行规范治疗对阻断梅毒母婴传播及预防不良妊娠结局具有重要意义。 Abstract:Objective To analyze the infection characteristics and the influencing factors of adverse pregnancy outcomes in pregnant women suffered from syphilis in Guangdong province, and provide evidence for the development of prevention and control measures to reduce the incidence of adverse pregnancy outcomes. Methods The information of pregnant women suffered from syphilis and newborns in Guangdong from 2015 to 2020 were collected from “National Information Management System for the Prevention of Mother to Child Transmission of AIDS, Syphilis and Hepatitis B”, and χ2 test and multivariate logistic regression analysis were conducted to identify risk factors of adverse pregnancy outcomes of these pregnant women. Results The results of χ2 test showed that there were significant differences in the incidence of adverse pregnancy among the pregnant women with different age, education levels, marital status, previous diagnoses, current diagnosis times, stages of syphilis in current diagnosis, treatment status and initial treatment times (P<0.05). Multivariate Logistic regression analysis showed that the risk of adverse pregnancy was higher in those aged 20 years and below and those with primary education level. Those who were not diagnosed with syphilis previously had higher risk for adverse pregnancy (OR=1.350, 95% CI: 1.202−1.517). The risk for adverse pregnancy was higher in the pregnant women diagnosed with syphilis at and after delivery than in those diagnosed during pregnancy. The unmarried women had higher risk for adverse pregnancy than the married women (OR=1.280, 95% CI: 1.027−1.420). The risk of adverse pregnancy was higher in the pregnant women with phase Ⅱ or Ⅲ syphilis than in those with recessive syphilis (OR=1.882, 95% CI: 1.039−3.195). The risk of adverse pregnancy was higher in the pregnant women without treatment (OR=3.465, 95% CI: 2.508−4.786). The risk of adverse pregnancy was higher in the pregnant women receiving treatment later in pregnancy than in patients receiving treatment early in pregnancy (OR=2.245, 95% CI: 1.850−2.724). Conclusion Age, education level, marital status, diagnosis and treatment time are the influencing factors of adverse pregnancy outcomes in pregnant women suffered from syphilis. Early screening, diagnosis and timely standardized treatment are of great importance in blocking mother to child transmission of syphilis and preventing adverse pregnancy outcomes. -
表 1 不同年份梅毒感染孕产妇治疗情况及不良妊娠结局情况比较
Table 1. Comparison of treatment and adverse pregnancy outcomes of pregnant women suffered from syphilis in different years
年份 报告病例数
(例)实施治疗 发生不良妊娠结局 例数
(例)治疗率
(%)例数
(例)发病率
(%)2015 1 767 1 432 81.04 179 10.13 2016 3 453 2 904 84.10 303 8.77 2017 3 204 2 817 87.92 227 7.08 2018 3 330 2 979 89.46 235 7.06 2019 3 563 3 235 90.79 256 7.18 2020 3 595 3 411 94.88 214 5.95 合计 18 912 16 778 88.72 1 414 7.48 表 2 不同特征梅毒感染孕产妇发生不良妊娠结局情况的比较
Table 2. Comparison of adverse pregnancy outcomes among pregnant women suffered from syphilis with different characteristics
特征 调查数(例) 构成比(%) 不良妊娠结局 病例数(例) 发生率(%) χ2值 P值 年龄组(岁) 54.162 <0.01 0~ 1 221 6.46 152 12.45 21~ 4 225 22.34 333 7.88 26~ 5 126 27.10 350 6.83 31~ 4 646 24.57 302 6.50 36~ 3 694 19.53 277 7.50 民族 0.004 0.950 汉族 17 607 93.10 1317 7.48 其他 1 305 6.90 97 7.43 文化程度 46.445 <0.01 小学及以下 2 072 10.96 222 10.71 初/高中 14 083 74.46 1 013 7.19 大学及以上 1 647 8.71 86 5.22 不详 1 110 5.87 93 8.38 职业 3.027 0.220 农/渔/牧民 2 370 12.53 179 7.55 家务及待业 10 661 56.37 824 7.73 其他 5 881 31.10 411 6.99 婚姻状况 29.921 <0.01 在婚 16 446 86.96 1 163 7.07 不在婚 2 466 13.04 251 10.18 产次 0.739 0.390 初产妇 5 999 31.72 463 7.72 经产妇 12 913 68.28 951 7.37 既往诊断梅毒 67.517 <0.01 是 8 953 47.34 521 5.82 否 9 959 52.66 893 8.97 本次诊断梅毒时期 91.656 <0.01 孕期 15 019 79.42 984 6.56 产时 2 663 14.08 293 11.00 产后 1 163 6.15 132 11.35 不详 67 0.35 5 7.46 本次诊断梅毒分期 34.084 <0.01 隐性 16 586 87.70 1 173 7.07 Ⅰ期 577 3.05 54 9.22 Ⅱ/Ⅲ期 114 0.60 15 13.16 不详 1635 8.65 172 10.58 感染途径 2.631 0.621 性传播 7 159 37.86 545 7.61 血液传播 116 0.61 12 10.35 母婴传播 100 0.53 6 6.00 其他 72 0.38 7 9.72 不详 11 465 60.62 844 7.36 接受治疗 49.414 <0.01 是 16 778 88.72 1 174 7.00 否 2 134 11.28 240 11.25 首次治疗时期 230.641 <0.01 孕早期 3 496 18.48 171 4.89 孕中期 8 330 44.05 481 5.77 孕晚期 3 629 19.19 470 12.95 孕前期 64 0.34 5 7.81 其他 3 393 17.94 287 8.46 表 3 梅毒感染孕产妇发生不良妊娠结局影响因素分析
Table 3. Influencing factors of adverse pregnancy outcome in pregnant women suffered from syphilis
影响因素 β $s_{\bar x}$ Wald χ2值 P值 OR值(95%CI) 年龄组(岁) 0~ 1.000 21~ −0.258 0.112 5.286 0.021 0.772(0.620~0.963) 26~ −0.359 0.114 9.881 0.002 0.698(0.558~0.874) 31~ −0.443 0.117 14.322 <0.01 0.642(0.510~0.808) 36~ −0.364 0.118 9.444 0.002 0.695(0.551~0.877) 文化程度 小学及以下 1.000 初/高中 −0.278 0.081 11.877 0.001 0.757(0.647~0.887) 大学及以上 −0.419 0.135 9.577 0.002 0.658(0.504~0.858) 婚姻 在婚 1.000 不在婚 0.189 0.083 5.227 0.022 1.280(1.027~1.420) 既往诊断 是 1.000 否 0.300 0.060 25.459 <0.01 1.350(1.202~1.517) 本次诊断时期 孕期 1.000 产时 0.306 0.084 13.424 <0.01 1.358(1.153~1.600) 产后 0.289 0.112 6.681 0.001 1.335(1.072~1.663) 本次诊断梅毒分期 隐性 1.000 Ⅱ/Ⅲ期 0.600 0.287 4.380 0.036 1.822(1.039~3.195) 不详 0.279 0.089 9.883 0.002 1.322(1.111~1.572) 接受治疗 是 1.000 否 1.243 0.165 56.847 <0.01 3.465(2.508~4.786) 首次治疗时期 孕早期 1.000 孕晚期 0.809 0.099 67.063 <0.01 2.245(1.850~2.724) -
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