妊娠合并梅毒孕妇不同治疗时机与新生儿不良结局的关联  

Association between different treatment timings and adverse neonatal outcomes in pregnant women with syphilis during pregnancy

作　　者：胡芳 黄兆谦 蔡敏 徐慧芳 江洪波 高爽[3] Hu Fang;Huang Zhaoqian;Cai Min;Xu Huifang;Jiang Hongbo;Gao Shuang(Department of Child Health Care,Guangzhou Women and Children′s Medical Center,Guangzhou Medical University,Guangzhou 510623,China;School of Public Health,Guangdong Pharmaceutical University,Guangzhou 510006,China;Department of Maternity Group Health,Guangdong Province Maternal and Child Health Care Hospital,Guangzhou 511400,China;Guangdong Association of STD&AIDS Prevention and Control,Guangzhou 511430,China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心儿童保健部,广州510623 [2]广东药科大学公共卫生学院,广州510006 [3]广东省妇幼保健院孕产群体保健科,广州511400 [4]广东省性病艾滋病防治协会,广州511430

出　　处：《中华预防医学杂志》2023年第11期1782-1787,共6页Chinese Journal of Preventive Medicine

基　　金：广东省医学科学技术研究基金项目(B2023086)。

摘　　要：目的分析妊娠合并梅毒孕妇不同治疗时机与新生儿不良结局(早产、死亡、先天性梅毒)的关联。方法利用国家“预防艾滋病、梅毒和乙肝母婴传播管理信息系统”监测收集的2011年10月至2021年12月广东省妊娠合并梅毒孕妇及其所生新生儿检测治疗等信息。根据梅毒孕妇首次进行青霉素治疗时所处孕周,分为孕早期治疗、孕中期治疗、孕晚期治疗和孕期未进行治疗4组。采用多因素logistic回归模型分析梅毒孕妇不同治疗时机与新生儿不良结局的关联。结果共纳入22483例梅毒孕妇,孕早期、孕中期、孕晚期启动治疗和孕期未进行治疗的孕妇分别为4549例(20.23%)、8719例(38.78%)、2235例(9.94%)和6980例(31.05%)。与孕早期启动治疗的孕妇相比,孕期未进行驱梅治疗的孕妇,其所生新生儿早产(OR=1.42,95%CI:1.24~1.62)、死亡(OR=4.27,95%CI:1.64~14.69)和先天性梅毒(OR=12.26,95%CI:6.35~27.45)发生风险均增加,孕中期(OR=2.68,95%CI:1.34~6.16)、孕晚期(OR=6.27,95%CI:2.99~14.80)启动驱梅治疗的孕妇,其所生新生儿罹患先天性梅毒的风险增加。结论对妊娠合并梅毒孕妇,孕期应尽早启动驱梅治疗,以减少新生儿不良结局的发生。Objective To analyze the association between different treatment timings and adverse neonatal outcomes(premature birth,death,congenital syphilis)in syphilis-infected pregnant women.Methods The National Management Information System for Prevention of HIV,Syphilis and HBV Mother-to-Child Transmission was used to collect information on the detection and treatment of syphilis-infected pregnant women and their newborns in Guangdong Province from October 2011 to December 2021.According to the gestational weeks of syphilis-infected pregnant women receiving penicillin treatment for the first time,they were divided into four groups:treatment in the first trimester,treatment in the second trimester,treatment in the third trimester,and no treatment during pregnancy.Multivariate logistic regression was used to analyze the association between different treatment timings and adverse neonatal outcomes in syphilis-infected pregnant women.Results A total of 22483 syphilis-infected pregnant women were included.The number of pregnant women who started treatment in the first trimester,second trimester,and third trimester and did not receive treatment during pregnancy were 4549(20.23%),8719(38.78%),2235(9.94%)and 6980(31.05%),respectively.Compared with pregnant women who started treatment in the first trimester,pregnant women who did not receive anti-syphilis treatment during pregnancy had increased risks of neonatal preterm birth(OR=1.42,95%CI:1.24-1.62),death(OR=4.27,95%CI:1.64-14.69)and congenital syphilis(OR=12.26,95%CI:6.35-27.45).At the same time,the risk of congenital syphilis in the newborns of pregnant women who started anti-syphilis treatment in the second trimester(OR=2.68,95%CI:1.34-6.16)and third trimester(OR=6.27,95%CI:2.99-14.80)also increased.Conclusion Early initiation of anti-syphilis treatment during pregnancy in patients with syphilis can improve neonatal outcomes.

关 键 词：梅毒 妊娠 治疗时机 新生儿 结局 监测 

分 类 号：R714.2[医药卫生—妇产科学]