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Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis.

Hawkes SJ, Gomez GB, Broutet N - PLoS ONE (2013)

Bottom Line: All showed a lower prevalence of any adverse outcome among women who received an intervention (to include screening and treatment) in the first and second trimesters of pregnancy compared to the third trimester.Women who sought care in the first two trimesters of their pregnancy, and received the appropriate intervention, were more likely to have a healthy infant, compared to women screened and treated in the third trimester.For interventions to be effective within these health programmes, health systems and community engagement programmes need to be strengthened to enable pregnant women to seek antenatal care early.

View Article: PubMed Central - PubMed

Affiliation: University College London Institute for Global Health, University College London, London, United Kingdom. s.hawkes@ucl.ac.uk

ABSTRACT

Objective: Despite an increase in the proportion of women who access antenatal care, mother-to-child transmission of syphilis continues to be a consequence of undiagnosed, untreated, or inadequately treated maternal syphilis. We reviewed evidence on the optimal timing of antenatal interventions to prevent mother-to-child transmission of syphilis and its associated adverse outcomes.

Design: Systematic review and meta-analysis of published literature. English-language articles were included if they (1) reported the gestational age at which the mother was screened or tested for syphilis; (2) reported on pregnancy outcome. No publication date limits were set.

Results: We identified a total of 1,199 publications, of which 84 were selected for further review and five were included. All showed a lower prevalence of any adverse outcome among women who received an intervention (to include screening and treatment) in the first and second trimesters of pregnancy compared to the third trimester. The overall odds ratio for any adverse outcome was 2.24 (95% CI 1.28, 3.93). All sub-analyses by type of outcome presented important heterogeneity between studies, except for those studies reporting an infected infant (odds ratio 2.92, 95% CI 0.66, 12.87; I(2) = 48.2%, p = 0.165).

Conclusions: Our review has shown that the timing of antenatal care interventions makes a significant difference in the risk of having an adverse outcome due to syphilis. Women who sought care in the first two trimesters of their pregnancy, and received the appropriate intervention, were more likely to have a healthy infant, compared to women screened and treated in the third trimester. Encouraging ALL pregnant women to seek care in the first two trimesters of their pregnancy should be a priority for health programmes. For interventions to be effective within these health programmes, health systems and community engagement programmes need to be strengthened to enable pregnant women to seek antenatal care early.

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Related in: MedlinePlus

Sub-group meta-analyses.Ref, reference; wks, weeks; d, days. All adverse pregnancy outcomes (APOs) included: low birth weight, stillbirth, and preterm birth for Watson-Jones 2002; low birth weight, preterm birth, intrauterine death for Carles 2008; congenital syphilis, foetal death, and neonatal death for Zhu 2010.
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pone-0056713-g004: Sub-group meta-analyses.Ref, reference; wks, weeks; d, days. All adverse pregnancy outcomes (APOs) included: low birth weight, stillbirth, and preterm birth for Watson-Jones 2002; low birth weight, preterm birth, intrauterine death for Carles 2008; congenital syphilis, foetal death, and neonatal death for Zhu 2010.

Mentions: The odds ratio for any adverse outcomes from being screened and treated in the third trimester compared to the first and second trimesters was 2.24 (95% CI 1.28, 3.93) – see Figure 3. However, an important amount of heterogeneity was observed (I2 = 71.0%, p = 0.008). To explore the sources of heterogeneity, Figure 4 shows the results of the sensitivity analyses. The OR for studies that reported only “congenital syphilis” (infected infant) events could be pooled to be 2.92 (95% CI 0.66, 12.87; I2 = 48.2%, p = 0.165). All other sub-analyses presented important heterogeneity between studies. However, there was a strong indication of an increased risk of adverse outcomes if women delay ANC care independently of treatment available or description of the intervention: the pooled ORs ranged from 2.42 (95% CI 1.27, 4.59; I2 = 78.3%, p = 0.003) for studies reporting treatment with benzathine penicillin G only compared to those reporting treatment with aqueous penicillin to 2.70 (95% CI 1.13, 6.44; I2 = 78.3%, p = 0.003) for studies that reported on gestational age at treatment only as opposed to gestational age at treatment or first ANC.


Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis.

Hawkes SJ, Gomez GB, Broutet N - PLoS ONE (2013)

Sub-group meta-analyses.Ref, reference; wks, weeks; d, days. All adverse pregnancy outcomes (APOs) included: low birth weight, stillbirth, and preterm birth for Watson-Jones 2002; low birth weight, preterm birth, intrauterine death for Carles 2008; congenital syphilis, foetal death, and neonatal death for Zhu 2010.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585307&req=5

pone-0056713-g004: Sub-group meta-analyses.Ref, reference; wks, weeks; d, days. All adverse pregnancy outcomes (APOs) included: low birth weight, stillbirth, and preterm birth for Watson-Jones 2002; low birth weight, preterm birth, intrauterine death for Carles 2008; congenital syphilis, foetal death, and neonatal death for Zhu 2010.
Mentions: The odds ratio for any adverse outcomes from being screened and treated in the third trimester compared to the first and second trimesters was 2.24 (95% CI 1.28, 3.93) – see Figure 3. However, an important amount of heterogeneity was observed (I2 = 71.0%, p = 0.008). To explore the sources of heterogeneity, Figure 4 shows the results of the sensitivity analyses. The OR for studies that reported only “congenital syphilis” (infected infant) events could be pooled to be 2.92 (95% CI 0.66, 12.87; I2 = 48.2%, p = 0.165). All other sub-analyses presented important heterogeneity between studies. However, there was a strong indication of an increased risk of adverse outcomes if women delay ANC care independently of treatment available or description of the intervention: the pooled ORs ranged from 2.42 (95% CI 1.27, 4.59; I2 = 78.3%, p = 0.003) for studies reporting treatment with benzathine penicillin G only compared to those reporting treatment with aqueous penicillin to 2.70 (95% CI 1.13, 6.44; I2 = 78.3%, p = 0.003) for studies that reported on gestational age at treatment only as opposed to gestational age at treatment or first ANC.

Bottom Line: All showed a lower prevalence of any adverse outcome among women who received an intervention (to include screening and treatment) in the first and second trimesters of pregnancy compared to the third trimester.Women who sought care in the first two trimesters of their pregnancy, and received the appropriate intervention, were more likely to have a healthy infant, compared to women screened and treated in the third trimester.For interventions to be effective within these health programmes, health systems and community engagement programmes need to be strengthened to enable pregnant women to seek antenatal care early.

View Article: PubMed Central - PubMed

Affiliation: University College London Institute for Global Health, University College London, London, United Kingdom. s.hawkes@ucl.ac.uk

ABSTRACT

Objective: Despite an increase in the proportion of women who access antenatal care, mother-to-child transmission of syphilis continues to be a consequence of undiagnosed, untreated, or inadequately treated maternal syphilis. We reviewed evidence on the optimal timing of antenatal interventions to prevent mother-to-child transmission of syphilis and its associated adverse outcomes.

Design: Systematic review and meta-analysis of published literature. English-language articles were included if they (1) reported the gestational age at which the mother was screened or tested for syphilis; (2) reported on pregnancy outcome. No publication date limits were set.

Results: We identified a total of 1,199 publications, of which 84 were selected for further review and five were included. All showed a lower prevalence of any adverse outcome among women who received an intervention (to include screening and treatment) in the first and second trimesters of pregnancy compared to the third trimester. The overall odds ratio for any adverse outcome was 2.24 (95% CI 1.28, 3.93). All sub-analyses by type of outcome presented important heterogeneity between studies, except for those studies reporting an infected infant (odds ratio 2.92, 95% CI 0.66, 12.87; I(2) = 48.2%, p = 0.165).

Conclusions: Our review has shown that the timing of antenatal care interventions makes a significant difference in the risk of having an adverse outcome due to syphilis. Women who sought care in the first two trimesters of their pregnancy, and received the appropriate intervention, were more likely to have a healthy infant, compared to women screened and treated in the third trimester. Encouraging ALL pregnant women to seek care in the first two trimesters of their pregnancy should be a priority for health programmes. For interventions to be effective within these health programmes, health systems and community engagement programmes need to be strengthened to enable pregnant women to seek antenatal care early.

Show MeSH
Related in: MedlinePlus