Factors associated with gestational syphilis in Primary Health Care: a case-control study

Lino, Carolina Matteussi; Maeda, Sayuri Tanaka; Sousa, Maria da Luz Rosário; Antunes, José Leopoldo Ferreira; Batista, Marília Jesus

doi:10.1590/1806-9304202500000276-en

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 25 • 2025 • https://doi.org/10.1590/1806-9304202500000276-en linkcopy

Factors associated with gestational syphilis in Primary Health Care: a case-control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives: to analyze the factors associated with the occurrence of syphilis in pregnant women attending in Primary Health Care.

Methods: case-control study conducted with women who underwent prenatal care in Primary Health Care. Three controls were selected for each case (48 cases and 144 controls) based on the results of serological tests for syphilis. Bivariate analysis was carried out, followed by conditional logistic regression ordered by pairs from the lowest p value.

Results: in the control and case groups there was a predominance of, respectively: women aged 20 to 34 (52.1%; 21.4%), single (48.4%; 21.4%), black or brown (46.9%; 16.1%), with nine or more years of schooling (47.4%; 12.5%). The associated factors were a history of illicit drug use (OR = 3.42; 95%CI= 1.18 - 9.90) and a previous diagnosis of Sexually Transmitted Infection (OR = 6.63; 95%CI=2.18 - 20.16).

Conclusion: the consumption of illicit substances and the presence of previous Sexually Transmitted Infection were factors associated with syphilis during pregnancy. The findings reinforce the importance of planning and reorganizing actions during prenatal care aimed at identifying and managing subjective factors, so that health services can adopt effective measures to monitor and prevent new cases of syphilis in pregnant women.

Key words
Sexually transmitted diseases; Pregnant women; Maternal and child health

Variables	Control		Case		p
Variables	n	%	n	%	p
Age group (years)					0.870¹
14 - 19	26	13.5	7	3.7
20 - 34	100	52.1	35	18.2
35 or more	18	9.4	6	3.1
Marital status					0.006¹
Married	51	26.6	7	3.6
Single	93	48.4	41	21.4
Self-declared skin color					0.796¹
White	54	28.1	17	8.9
Black/Brown	90	46.9	31	16.1
Household of residence					0.182¹
Own	73	38.0	19	9.9
Rented/Lent	71	37.0	29	15.1
Has any religion					0.240¹
Yes	103	53.6	30	15.6
No	41	21.4	18	9.4
Schooling (years)					0.106¹
Up to 8	53	27.6	24	12.5
9 or more	91	47.4	24	12.5
Paid work					0.933¹
No	76	39.6	25	13.0
Yes	68	35.4	23	12.0
Income transfer programa					0.077¹
No	109	56.8	30	15.6
Yes	35	18.2	18	9.4
Individual income					0.144¹
Up to 1 minimum-wage	48	25.0	16	8.3
More than 1 minimum-wage	35	18.2	18	9.4
No income	61	31.8	14	7.3
Tobacco use					0.002¹
Never	118	61.5	29	15.1
Used/currently uses	26	13.5	19	9.9
Time of tobacco use					0.0802
Up to 1 year	5	11.4	3	6.8
From 1 to 5 years	12	27.3	3	6.8
More than 5 years	9	20.4	12	27.3
Alcohol use					0.011¹
Never	45	23.4	6	3.1
Used/currently uses	99	51.6	42	21.9
Use of illicit drugs					0.000¹
Never	128	66.7	32	16.7
Used/currently uses	16	8.3	16	8.3
Time of illicit drugs use					0.6732
Up to 1 year	6	23.1	2	7.7
From 1 to 5 years	7	26.9	5	19.2
More than 5 years	3	11.5	3	11.5
Age of first sexual intercourse					0.002¹
Up to 15 years	67	37.0	34	18.8
16 years or more	69	38.1	11	6.1
Number of partners in the previous year					0.0132
1 partner	127	68.3	34	18.3
2 partners or more	14	7.5	11	5.9
Number of pregnancies					0.611¹
Primipara	57	29.7	21	10.9
Multipara	87	45.3	27	14.1
Abortion history					0.113¹
No	120	62.5	35	18.2
Yes	24	12.5	13	6.8
Use of contraceptive methods					0.018¹
No	53	27.6	27	14.1
Yes	91	47.4	21	10.9
Condom Use					0.396¹
Always/sometimes	36	18.8	15	7.8
Never/rarely	108	56.2	33	17.2
Previous Sexually Transmittable Disease					0.000¹
No	134	69.8	30	15.6
Yes	10	5.2	18	9.4

Variables	Unadjusted			Adjusted*
Variables	OR	95%CI	p	OR	95%CI	p
Marital status
Married	1	-	-	.	.	.
Single	2.99	1.28 - 7.02	0.011	.	.	.
Household of residence
Owned	1	-	-	.	.	.
Rented/Lent	1.67	0.82 - 3.41	0.160	.	.	.
Schooling (in years)
Up to 8 years	1.68	0.88 - 3.23	0.117	.	.	.
9 years or more	1	-	-	.	.	.
Income transfer program
No	1	-	-	1	-	-
Yes	2.04	0.96 - 4.34	0.006	1.54	0.58 - 4.05	0.378
Individual income (in minimum-wages)
Up to 1	1	-	-	.	.	.
More than 1	1.54	0.69 - 3.57	0.317	.	.	.
No income	0.67	0.28 - 1.60	0.371	.	.	.
Tobacco use
Never	1	-	-	.	.	.
Used/currently uses	2.84	1.39 - 5.87	0.004	.	.	.
Time of tobacco use
Up to 1 year	1	-	-	.	.	.
From 1 to 5 years	0.42	0.06 - 2.81	0.369	.	.	.
More than 5 years	2.22	0.42 - 11.83		.	.	.
Alcohol use
Never	1	-	-	1	-	-
Used/currently uses	2.96	1.20 - 7.33	0.018	2.78	0.98 – 7.87	0.053
Illicit drug use
Never	1	-	-	1	-	-
Used/currently uses	4.56	1.90 - 10.92	0.001	3.42	1.18 – 9.90	0.023
Age of the first sexual intercourse
Up to 15 years	4.35	1.79 - 9.04	0.001	.	.	.
16 years or more	1	-	-	.	.	.
Number of partners in the last 12 months
1 partner	1	-	-	.	.	.
2 partners or more	3.43	1.30 - 9.04	0.013	.	.	.
Abortion history
No	1	-	-	1	-	-
Yes	1.82	0.85 - 3.93	0.124	1.64	0.64 - 4.25	0.305
Use of contraceptive methods
No	1	-	-	1	-	-
Yes	0.45	0.23 - 0.88	0.020	0.49	0.21 - 1.13	0.095
Previous Sexually Transmittable Disease
No	1	-	-	1	-	-
Yes	7.82	3.07 - 19.87	0.001	6.63	2.18 - 20.16	0.001

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Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
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[TN1] ^*
Some variables did not total n=192 since they present unknown information;

[TN2] ^a
Emergency Aid (COVID-19), Bolsa Família/Auxílio Brasil; Independent Chi square test;

[TN3] ²
Fisher’s exact test; (p<0.05).