Factors associated with prematurity in reported cases of congenital syphilis

Araújo, Maria Alix Leite; Esteves, Ana Beatriz Barbosa; Rocha, Ana Fátima Braga; Silva Junior, Geraldo Bezerra da; Miranda, Angelica Espinosa

doi:10.11606/s1518-8787.2021055002400

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002400 copy

Factors associated with prematurity in reported cases of congenital syphilis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil.

METHODS:

Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers’ and babies’ medical records and from prenatal cards. For the bivariate analysis, Pearson’s chi-squared and Fisher’s exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval.

RESULTS:

We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33–4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74–7.13; p< 0.001) were associated with higher chances of prematurity.

CONCLUSION:

The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.

DESCRIPTORS:
Syphilis, Congenital; Infectious Disease Transmission, Vertical; Prenatal Care; Infant, Premature; Penicillin G

Variables		n^a a Not all patients underwent prenatal care or all tests for syphilis, so the “n” of some variables is different.	%
Age (in years)
	≤ 19	15	20.5
	20–29	41	56.2
	≥ 30	17	23.3
Marital status
	With steady partner	36	49.3
	Without steady partner	37	50.7
Education level (years of study)
	Complete elementary school	54	74.0
	Incomplete high school / complete high school / higher education	19	26.0
Has paid work
	Yes	13	17.8
	No	60	82.2
Illicit drug user
	Yes	26	35.6
	Not/ignored	47	64.4
Attended prenatal care
	Yes	52	71.2
	No	21	28.8
Number of prenatal consultations
	1	8	15.4
	2 to 5	26	50.0
	≥ 6	18	34.6
Onset of prenatal care
	First trimester	23	44.2
	Second trimester	20	38.5
	Third trimester	9	17.3
Number of tests for syphilis in prenatal care^b b Rapid test or VDRL test.
	None	15	28.9
	1	31	59.6
	2	6	11.5
Prenatal syphilis test result^b b Rapid test or VDRL test.
	Reactive	21	56.8
	Nonreactive	16	43.2
VDRL titration in prenatal care^c c Only for those who underwent VDRL test.
	≤ 1:8	4	30.8
	> 1:8	9	69.2
Treatment during prenatal care
	Complete treatment^d d Treatment with three doses of benzathine penicillin (7.2 million IU) regardless of partner treatment.	4	7.7
	Incomplete treatment^d d Treatment with three doses of benzathine penicillin (7.2 million IU) regardless of partner treatment.	7	13.5
	Other drug/Untreated	41	78.8
VDRL titration at delivery
	≤ 1:8	41	56.2
	> 1:8	32	43.8

Variables		VDRL delivery > 1:8
Variables		Total cases of congenital syphilis (n = 134)		Prematurity (n = 32)
Attended prenatal care
	Yes	111	82.8	24	75.0
	No	23	17.2	8	25.0
Number of prenatal consultations
	1	8	7.2	5	20.8
	2 to 5	53	47.7	13	54.2
	≥ 6	50	45.0	6	25.0
Onset of prenatal care
	First trimester	49	44.2	8	33.3
	Second trimester	45	40.5	10	41.7
	Third trimester	17	15.3	6	25.0
Number of tests for syphilis in prenatal care^b b Rapid test or VDRL test.
	None	28	25.2	9	37.5
	1	65	58.6	13	54.2
	2	18	16.2	2	8.3
Prenatal syphilis test result^b b Rapid test or VDRL test.
	Reactive	65	78.3	6	40.0
	Nonreactive	18	21.7	9	60.0
VDRL titration in prenatal care^c c Only for those who underwent VDRL test.
	≤ 1:8	13	23.6	–	–
	> 1:8	42	76.4	6	100.0
Treatment during prenatal care
	Complete treatmen^td	24	21.6	–	–
	Incomplete treatment^d	22	19.8	3	12.5
	Other drug/Untreated	65	58.6	21	87.5

Variables		n (%)	Prematurity				p	Crude OR (95%CI)
			Yes		No
			n	%	n	%
Age (in years)							0.484
	≥ 19	405 (84.7)	60	14.8	345	85.2		1
	≤ 18	73 (15.3)	13	17.8	60	82.2		1.25 (0.64–2.41)
Marital status							0.250
	With steady partner	267 (55.8)	36	13.5	231	86.5		1
	Without steady partner	211 (44.2)	37	17.5	174	82.5		1.36 (0.83–2.25)
Education level (years of study)							0.410
	Incomplete high school / complete high school / higher education	145 (30.3)	19	13.1	126	86.9		1
	Complete elementary school	333 (69.7)	54	16.2	279	83.8		1.28 (0.73–2.25)
Has paid work							0.060
	Yes	128 (26.8)	13	10.2	115	89.8		1
	No	350 (73.2)	60	17.1	290	82.9		1.83 (0.97–3.46)
Illicit drug user							0.001
	Not/ignored	376 (78.7)	47	12.5	329	87.5		1
	Yes	102 (21.3)	26	25.5	76	74.5		2.39 (1.39–4.11)
Attended prenatal care							0.004
	Yes	396 (82.8)	52	13.1	344	86.9		1
	No	82 (17.2)	21	25.6	61	74.4		2.28 (1.28–4.05)
Time of syphilis diagnosis							< 0.001
	Prenatal care	267 (55.9)	23	8.6	244	91.4		1
	Delivery	211 (44.1)	50	23.7	161	76.3		3.29 (1.93–5.61)
VDRL titration at delivery							0.001
	≤ 1:8	344 (72.0)	41	11.9	303	88.1		1
	> 1:8	134 (28.0)	32	23.9	102	76.1		2.31 (1.38–3.87)

Variables		n (%)	Prematurity				p	Crude OR (95%CI)
			Yes		No
			n	%	n	%
Number of consultations							0.005
	≥ 6	209 (52.8)	18	8.6	191	91.4		1
	< 6	187 (47.2)	34	18.2	153	81.8		2.35 (1.28–4.33)
Onset of prenatal care							0.092
	First and second trimesters	354 (89.4)	43	12.1	311	87.9		1
	Third trimester	42 (10.6)	9	21.4	33	78.6		1.97 (0.88–4.40)
Number of tests for syphilis in prenatal care							0.008
	At least one	332 (83.8)	37	11.1	295	88.9		1
	None	64 (16.2)	15	23.4	49	76.6		2.44 (1.24–4.77)
Underwent two VDRL tests in prenatal care							0.112
	Yes	78 (19.7)	6	7.7	72	92.3		1
	Not/ignored	318 (80.3)	46	14.5	272	85.5		2.02 (0.83–4.93)
Treatment of the pregnant women in prenatal care							< 0.001
	With benzathine penicillin	180 (45.4)	11	6.1	169	93.9		1
	Other drug/Untreated	216 (54.6)	41	19.0	175	81.0		3.59 (1.79–7.23)

Variables		n (%)	Adjusted OR (95%CI)	p
VDRL titration at delivery				0.004
	≤ 1:8	344 (72.0)	1
	> 1:8	134 (28.0)	2.46 (1.33–4.53)
Treatment of pregnant women in prenatal care				< 0.001
	With benzathine penicillin	180 (45.4)	1
	Other drug/Untreated	216 (54.6)	3.52 (1.74–7.13)

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[1] Correspondence: Maria Alix Leite Araújo, Av. Washington Soares, 1321 60811-905 Fortaleza, CE, Brasil E-mail: mleite@unifor.br