title: Gestational syphilis and stillbirth in Latin America and the Caribbean.
abstract: OBJECTIVE
  To measure the association between gestational syphilis and stillbirth in Latin America and the Caribbean.
  
  
  METHODS
  In a retrospective study, data on stillbirth and gestational syphilis extracted from the Sistema Informático Perinatal database were analyzed for deliveries in 11 countries between January 1, 2009, and December 31, 2012. Potential confounders were examined, and binary logistic regression analysis was performed to assess the association between gestational syphilis and stillbirth.
  
  
  RESULTS
  Among 368 151 deliveries, 3875 (1.1%) were by women with a positive syphilis test, and 1461 (0.4%) were stillbirths. Among the stillbirths, 29 (2.0%) were delivered by women with a positive syphilis test. After controlling for country, congenital anomalies, gestational age at labor, maternal age, and previous stillbirth, gestational syphilis was significantly associated with stillbirth (odds ratio 1.88, 95% confidence interval 1.25-2.83; P=0.002).
  
  
  CONCLUSIONS
  Gestational syphilis contributes to stillbirth in Latin America and the Caribbean. Interventions targeting gestational syphilis are highly cost-effective and should be implemented across the region.
authors.affiliation: Pan American Health Organization, Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Montevideo, Uruguay. Electronic address: laurenarnesen@gmail.com.
authors.forename: Lauren
authors.initials: L
authors.lastname: Arnesen
authors.affiliation: Pan American Health Organization, Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Montevideo, Uruguay.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Martínez
authors.affiliation: Pan American Health Organization, Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Montevideo, Uruguay.
authors.forename: Luis
authors.initials: L
authors.lastname: Mainero
authors.affiliation: Pan American Health Organization, Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Montevideo, Uruguay.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Serruya
authors.affiliation: Pan American Health Organization, Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Montevideo, Uruguay.
authors.forename: Pablo
authors.initials: P
authors.lastname: Durán
mesh_terms: D000328:Adult; D017691:Caribbean Region / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D016015:Logistic Models; D008423:Maternal Age; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000382:microbiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D013587:Syphilis / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult
keywords: Caribbean; Latin America; Mother-to-child transmission; Stillbirth; Syphilis