Gestational Syphilis and Stillbirth in Latin America and the Caribbean
METHODS: We analyzed births from the Perinatal Information System occurring between January 1, 2009 and December 31, 2012, quantifying the current relationship between gestational syphilis and stillbirth, and examining potential confounders. We did binary logistic regression to assess the association between syphilis and stillbirth.
RESULTS: Our final model included 368,151 births, of which 3,875 (1.1%) were exposed to gestational syphilis. 1,461 births (0.4%) were stillborn and 29 stillborn babies were born to women with syphilis. Gestational syphilis is associated with having 1.880 times the odds of stillbirth, controlling for country, congenital defects, gestational age at labor, mother’s age, and previous stillbirths.
Controlling for all other covariates in the final model, major congenital defects result in 25.898 times the odds of stillbirth. The odds of stillbirth are 2.845 when the mother has had previous stillbirth(s). As gestational age increases, the odds of stillbirth decrease, with each week increase being associated with 0.809 times the odds of stillbirth.
CONCLUSIONS: Gestational syphilis is a major contributing factor for stillbirths in Latin America and the Caribbean. New point-of-care syphilis testing allows healthcare providers to test and treat women at the same visit, which should be implemented to address loss to follow-up. Interventions targeting gestational syphilis are highly cost-effective and, along with point-of-care testing, should be implemented across the region.