Reported Estimates of Adverse Pregnancy Outcomes among Women with and without Syphilis: A Systematic Review and Meta-Analysis

BackgroundTo estimate probability of adverse pregnancy outcomes (APOs) among women with and without syphilis through a systematic review of published literatures.Methodology/Principal FindingsChinese and English literatures were searched for studies assessing pregnancy outcomes in the presence of maternal syphilis through August 2013. The prevalence estimates were summarized and analyzed by meta-analysis. Fifty-four literatures involving 11398 syphilitic women and 43342 non-syphilitic women were included from 4187 records initially found. Among untreated mothers with syphilis, pooled estimates were 76.8% for all APOs, 36.0% for congenital syphilis, 23.2% for preterm, 23.4% for low birth weight, 26.4% for stillbirth or fetal loss, 14.9% for miscarriage and 16.2% for neonatal deaths. Among syphilitic mother receiving treatment only in the late trimester (>28 weeks), pooled estimates were 64.4% for APOs, 40.6% for congenital syphilis, 17.6% for preterm, 12.4% for low birth weight, and 21.3% for stillbirth or fetal loss. Among syphilitic mothers with high titers (≥1∶8), pooled estimates were 42.8% for all APOs, 25.8% for congenital syphilis, 15.1% for preterm, 9.4% for low birth weight, 14.6% for stillbirth or fetal loss and 16.0% for neonatal deaths. Among non-syphilitic mothers, the pooled estimates were 13.7% for all APOs, 7.2% for preterm birth, 4.5% for low birth weight, 3.7% for stillbirth or fetal loss, 2.3% for miscarriage and 2.0% for neonatal death. Begg's rank correlation test indicated little evidence of publication bias (P>0.10). Substantial heterogeneity was found across studies in the estimates of all adverse outcomes for both women with syphilis (I2 = 93.9%; PI2 = 94.8%; PConclusions/SignificanceSyphilis continues to be an important cause of substantial perinatal morbidity and mortality, which reminds that policy-makers charged with resource allocation that the elimination of mother-to-child transmission of syphilis is a public health priority.背景 本研究旨在通过对已发表文献的系统综述（Systematic Review），评估感染梅毒与未感染梅毒的孕妇发生不良妊娠结局（Adverse Pregnancy Outcomes, APOs）的概率。 方法/研究结果 截至2013年8月，检索中、英文文献，筛选评估感染梅毒孕妇妊娠结局的相关研究。采用荟萃分析（Meta-Analysis）对患病率估计值进行汇总与分析。最初检索得到4187条记录，最终纳入54篇文献，共涉及11398名梅毒感染孕妇与43342名未感染梅毒孕妇。 在未接受治疗的梅毒孕妇中，所有不良妊娠结局的合并估算率为76.8%，先天性梅毒为36.0%，早产为23.2%，低出生体重为23.4%，死胎或胎儿丢失为26.4%，流产为14.9%，新生儿死亡为16.2%。 仅在妊娠晚期（>28周）接受治疗的梅毒孕妇中，不良妊娠结局的合并估算率为64.4%，先天性梅毒为40.6%，早产为17.6%，低出生体重为12.4%，死胎或胎儿丢失为21.3%。 梅毒滴度≥1:8的感染孕妇中，所有不良妊娠结局的合并估算率为42.8%，先天性梅毒为25.8%，早产为15.1%，低出生体重为9.4%，死胎或胎儿丢失为14.6%，新生儿死亡为16.0%。 未感染梅毒的孕妇中，所有不良妊娠结局的合并估算率为13.7%，早产为7.2%，低出生体重为4.5%，死胎或胎儿丢失为3.7%，流产为2.3%，新生儿死亡为2.0%。 Begg秩相关检验（Begg's rank correlation test）结果显示几乎无发表偏倚（publication bias，P>0.10）。针对梅毒感染孕妇与未感染孕妇的所有不良妊娠结局估计值，各项研究间均存在显著异质性（梅毒感染组：I²=93.9%；PI²=94.8%；P）结论与意义 梅毒仍是导致围产期发病率与死亡率（perinatal morbidity and mortality）显著升高的重要病因，这提示负责资源分配的决策者应将消除梅毒母婴传播（mother-to-child transmission）作为公共卫生工作的优先事项。