title: Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis of reported estimates of adverse pregnancy outcomes among untreated women with syphilis and women without syphilis.
  
  
  METHODS
  PubMed, EMBASE and Cochrane Libraries were searched for literature assessing adverse pregnancy outcomes among untreated women with seroreactivity for Treponema pallidum infection and non-seroreactive women. Adverse pregnancy outcomes were fetal loss or stillbirth, neonatal death, prematurity or low birth weight, clinical evidence of syphilis and infant death. Random-effects meta-analyses were used to calculate pooled estimates of adverse pregnancy outcomes and, where appropriate, heterogeneity was explored in group-specific analyses.
  
  
  RESULTS
  Of the 3258 citations identified, only six, all case-control studies, were included in the analysis. Pooled estimates showed that among untreated pregnant women with syphilis, fetal loss and stillbirth were 21% more frequent, neonatal deaths were 9.3% more frequent and prematurity or low birth weight were 5.8% more frequent than among women without syphilis. Of the infants of mothers with untreated syphilis, 15% had clinical evidence of congenital syphilis. The single study that estimated infant death showed a 10% higher frequency among infants of mothers with syphilis. Substantial heterogeneity was found across studies in the estimates of all adverse outcomes for both women with syphilis (66.5% [95% confidence interval, CI: 58.0-74.1]; I(2) = 91.8%; P < 0.001) and women without syphilis (14.3% [95% CI: 11.8-17.2]; I(2) = 95.9%; P < 0.001).
  
  
  CONCLUSIONS
  Untreated maternal syphilis is associated with adverse pregnancy outcomes. These findings can inform policy decisions on resource allocation for the detection of syphilis and its timely treatment in pregnant women.
authors.affiliation: Amsterdam Institute for Global Health and Development, Trinity Buildings, Building C, Pietersbergweg 17, PO Box 22700, 1100 DE Amsterdam, Netherlands. g.gomez@aighd.org
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Gomez
authors.forename: Mary L
authors.initials: ML
authors.lastname: Kamb
authors.forename: Lori M
authors.initials: LM
authors.lastname: Newman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mark
authors.forename: Nathalie
authors.initials: N
authors.lastname: Broutet
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Hawkes
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D010406:Penicillins / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth; D011295:Prenatal Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D050497:Stillbirth / Q000453:epidemiology*; D013587:Syphilis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013590:Syphilis, Congenital / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins