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Towards the Elimination of Mother to Child Transmission of Syphilis 2015-2020: Practice and Progress in Zhejiang Province, Eastern China


 Objectives

To estimate the progress towards elimination of mother-to-child transmission (EMTCT) of syphilis in Zhejiang province.
Methods

Data were obtained from Zhejiang provincial EMTCT network. Childbearing women infected with syphilis during 2015–2020 were recruited from. Joinpoint mode was used to analyze changing trends in syphilis screening, treatment and adverse pregnancy outcomes (APOs), presented as the annual percentage of change (APC). Multivariate logistic regression mode was used to investigate risk factors of APOs.
Results

Of 3,658,266 participants, an average maternal syphilis incidence was 0.38%.From 2015 to 2020, the coverage of syphilis screening in pregnancy (96.31–99.24%; P < 0.001) and coverage of antenatal health care (ANC) within 13 gestational weeks were increased (55.27–77.82%; P = 0.002).The coverage of maternal syphilis treatment(88.30–98.25%; P = 0.001) and adequate treatment were also increased(66.92–83.37%; P = 0.001).Over years, the APC was − 19.30% (95%CI:-24.33~-13.92, P = 0.001 ) in perinatal death,-26.55% in congenital syphilis(95%CI:-38.75~-11.92, P = 0.009)and − 14.67% in infant with abnormal signs (95%CI:-23.96~-4.24, P = 0.019).In 2020, 11.58% of women had APOs. Women with syphilis infection during pregnancy aged (< 20 years) or (≥ 35 years), multiparous, with pregnancy complications increased (all P < 0.05).APOs risk increased in those with higher maternal RPR/TRUST titers, decreased when women had therapy, adequate therapy or early ANC, or aged in 21–34 years (all P < 0.001).
Conclusions

Despite steady progress towards the goal of EMTCT in implementing universal screening and treatment, syphilis continuously affects a large number of pregnant women. Increasing vulnerable women, small proportions of inadequately treated and delay in early ANC should be noticed.