Factors related to adverse pregnancy outcomes of maternal syphilis in Nanning Guangxi China 2016-2020

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Maternal syphilis not only severely affects the quality of life of pregnant women but also leads to various adverse pregnancy outcomes (APOs) and even congenital syphilis. This study aimed to investigate the association between maternal syphilis infection and adverse pregnancy outcomes in offspring. Multivariate logistic regression model was used to analyze the associations between maternal syphilis infection and APOs, and to explore its stability through subgroup analysis. 1624 pregnant women with syphilis in Nanning, Guangxi during 2016-2020 were selected as participants. The multivariate logistic regression analysis revealed that being under 20 years of age (OR: 1.911, 95% CI: 1.077-3.392), having an unknown titer prior to delivery (OR: 1.792, 95% CI: 1.194-2.688), and undergoing non-standardized treatment (OR: 1.448, 95% CI: 1.064-1.971) emerged as significant risk factors. The implementation of integrated prevention measures such as early syphilis screening, eugenics assessment and standardized treatment and follow-up of pregnant syphilis are of great significance in reducing the incidence of APOs for pregnant women infected with syphilis. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Maternal syphilis Pregnancy Adverse pregnancy outcome Influencing factors Figures Figure 1 Introduction Syphilis is a sexually transmitted genital ulcerative disease caused by Treponema pallidum, which could cause a range of adverse health outcome in the adults, pregnant women and infants. For instance, syphilis not only diminishes the quality and longevity of life but also manifests with an array of symptoms during its early stages, including sores, skin rashes, fever, fatigue, and adverse pregnancy outcomes among pregnant women[1]. Adverse pregnancy outcomes encompass preterm birth, stillbirth, and congenital syphilis. The clinical manifestations of congenital syphilis include rhinitis, periostitis or osteochondritis, hepatitis, pneumonitis, meningitis, hematologic derangements, as well as symptoms such as rash, fever, and failure to thrive[2,3]. Recent studies have revealed an alarming trend of escalating syphilis infections among pregnant women, with the prevalence of primary and secondary syphilis among females soaring by 172%, paralleled by a 185% increase in congenital syphilis cases between 2014 and 2018 in the United States. The same, the reported incidence of pregnant women infected with syphilis increased by 43% from 2016 to 2019. Certain studies also showed that the incidence of adverse pregnancy outcomes among pregnant women infected with syphilis in China has also significantly increased than those without syphilis[4,6]. Following rationale and strategy for action the global elimination of congenital syphilis was advocated in 2007, World Health Organization(WHO) launched the Global Initiative to Eliminate Mother-to-child Transmission of Syphilis and HIV (EMTCT) and the Global Guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis in 2014[7,8]. However, the burden of morbidity and mortality due to congenital syphilis is still high, there are 8 million adults infected with syphilis and 700 thousand congenital syphilis cases in 2022, underscoring the immense challenge in eradicating mother-to-child transmission of syphilis[9]. In response, the Ministry of Health of China established the integrated programmer for Prevention of Mother-to-child Transmission (PMTCT) of HIV, syphilis, and HBV in 2010[10], which aimed to prevent mother-to-child transmission by providing free testing counselling, and treatment services for women infected with syphilis. Current research on PWTCT has indicated that antenatal testing proportion was increased from 70.7% in 2012 to 94.4% in 2016 for syphilis in China, but, those pregnant women infected with syphilis did not received maternal standardized or any treatment, higher elevated non-treponema titre at diagnosis or before delivery were heightened risk factors for adverse pregnancy outcomes[11,13]. Guangxi Zhuang Autonomous Region is located in the southern coastal area of China, where economic development lags behind. The burden of syphilis infection among pregnant women in Guangxi is serious. Research indicates that the average incidence of syphilis among pregnant women in Guangxi was 0.17%, while the positive rate of syphilis at delivery was 0.67% from 2011 to 2016[14]. This study aims to explore the relevant factors associated with syphilis infection among pregnant in Nanning, Guangxi, from 2016 to 2020, and their impact on pregnancy outcomes, and then provide scientific evidence for further improving the standardized treatment and therapeutic outcomes of syphilis infections, thereby reducing adverse pregnancy outcomes. Methods Participants Pregnant women infected with syphilis reported in Nanning city, Guangxi from 2016 – 2020 were selected as the study population from the Prevention of mother-to-child transmission of Syphilis Management Information System (PMTCT). The inclusion criteria for this study were (1) positive serological antigen for both treponemal and non-treponemal in the pregnancy, (2)singleton pregnancy, (3)gestational age at delivery ≥28 weeks. The exclusion criteria were (1) severe complication, (2) no clear pregnancy outcome. Data source The data of pregnant women infected with syphilis was collected through the registration card for pregnant women infected with syphilis and the registration card for pregnant women and their newborns born with syphilis. The data was reviewed by the country and municipal level and reported through the Management information System for the Prevention of mother-to-child transmission of syphilis. The data collected included socio-demographic characteristics, pregnancy history, infection status, receiving services for the prevention of mother-to-child transmission of syphilis, pregnancy and delivery outcomes, and infection status of their husbands/sexual partners. Definitions APOs included stillbirth, preterm or low-birth-weight infants, death within 7 days, neonatal death, neonatal asphyxia, neonatal pulmonary inflammation, birth defect, or neonatal congenital syphilis. The standardized treatment meant the application of complete full and sufficient penicillin treatment, and the treatment was completed within 1 month before delivery according to the Prevention of Mother-to-child Transmission of HIV, Syphilis and Hepatitis B implementation plan. The untreated or non-standardized group meant that pregnant women infected with syphilis had not received any treatment or received treatment but were not implemented for syphilis. When the results of both the treponema pallidum antigen serum test and non-treponema pallidum antigen serum test were positive, pregnant women were diagnosed with syphilis. Statistical methods All statistical analyses were performed using R software (version 4.04) and IBM SPSS Statistics (version 26). Univariate and multivariate logistics regression models were used to analyze the factors influencing the outcome of pregnancy. The influencing factors of adverse pregnancy outcomes of maternal syphilis were firstly analyzed by the univariate analysis to determine whether independent variables such as demographic characteristics, clinical characteristics, syphilis treatment status, the titer at diagnosis, and the titer before delivery were independently related to APOs., and then the variables with differences ( P <0.05) were included in the multivariate logistic regression model. Binary logistic stepwise regression was used in multivariate analysis, with the inclusion criterion α = 0.05 and exclusion criterion α = 0.10. Both univariate and multivariate analyses were performed using SPSS22.0 software. P values < 0.05 were considered statistically significant. The OR and 95%CI were compared between the APOs group and the non-APOs groups. All the comparisons were two-sided, and the P -value of < 0.05 was considered significant. Results Demographics characteristics and the univariate analysis of adverse pregnancy outcomes of maternal syphilis As shown in Table 1, a total of 1624 pregnant women with syphilis were enrolled in this study, including 1426 pregnant women without APOs (87.81%) and 198 pregnant women with APOs (12.19%). Their average age was 31.46 ± 6.08 years. The median gestational age at which they were diagnosed with syphilis was 15 weeks. The majority of these women were first married, accounting for 77.03% (1251) of the total, with 11.02% (179), 10.59(172), and 1.35(22) being remarried, cohabiting, and divorced or Widowed, respectively. Among all 1624 pregnant women with syphilis, infected women of Zhuang ethnicity accounted for 53.08% (862), and 39.16% (636) were of Han nationality. Of these, 57.14% (928) had a history of syphilis infection, and only 20.26% (326) had a history of APOs with their child born in the past. Univariate analysis of factors affecting APOs in women infected with syphilis Univariate analysis indicated that, between maternal syphilis with and without adverse pregnancy outcomes, there was no significant difference in the distribution of Ethnicity, Education, Occupation, the number of Gravidity and Parity, Syphilis infection history, etc. (Table 1). (all P >0.05). While there was a significant difference ( P <0.05) in Age, Marital status, Titer at diagnosis, Abnormality during pregnancy, Titer before delivery, Initiation of treatment, and Standardized treatment (Table 1). The incidence of the APOs was the lowest in the 20~35-year group (10.68%) and the highest in the ≤20-year group (18.89%). Compared with women in the First married group, the Divorced or Widowed women had a higher incidence rate of APOs. Significant differences in Titer at diagnosis or before delivery group, the high titer 1:8 and unknown titer had a higher incidence rate of APOs. In addition, more people in the APOs group were untreated or had a non-standardized treatment than in the non-APOs group. Table 1 Epidemiological characteristics between the maternal syphilis with and without adverse pregnancy outcomes(n=1624) Characteristic Total n Without APOs n (%) With APOs n (%) c 2 P value Age, years ≤ 20 90 73(81.11) 17(18.89) 8.332 0.016 20~35 1086 970(89.32) 116(10.68) ≥35 448 383(85.49) 65(14.51) Ethnicity Han 636 554（87.11） 82（12.89） 0.834 0.659 Zhuang 862 761（88.97） 101（11.72） Other 136 121（88.97） 15（11.03） Education Primary School or lower 196 173（88.27） 23（11.73） 3.167 0.530 Junior school 893 773（86.56） 120（13.44） Senior school 279 250（89.61） 29（10.39） College or above 157 141（89.81） 16（10.19） Unknown 99 89（89.90） 10（10.10） Occupation Farmer or Peasant workers 785 694（88.41） 91（11.59） 0.780 0.677 Housekeeping or unemployment 467 405（86.72） 62（13.28） Other 372 327（87.90） 45（12.10） Marital status First married 1251 1114（89.05） 137（10.98） 9.670 0.022 Divorced or Widowed 22 18（81.82） 4（18.18） Cohabiting 172 140（81.40） 32（18.60） Remarried 179 154（86.03） 25（13.97） Gravidity 1 226 194（85.16） 32（14.16） 2.045 0.563 2 440 385（87.50） 55（12.50） 3 420 376（89.52） 44（10.48） ≥4 538 471（87.55） 67（12.45） Parity 0 362 308（85.08） 54（14.92） 6.695 0.082 1 451 642（87.82） 89（12.18） 2 389 354（91.00） 35（9.00） ≥3 142 122（85.92） 20（14.08） Previous with APOs Yes 329 279（84.80） 50（15.20） 3.481 0.062 No 1295 1147（88.57） 148（11.43） Syphilis infection history Yes 928 825（88.90） 103（11.10） 2.416 0.120 No 696 601（86.35） 95（13.65） Husband/partner infection status Infected 84 74（88.10） 10（11.90） 0.208 0.976 Uninfected 398 351（88.19） 47（11.81） Unknown 371 327（88.14） 44（11.86） Undetected 771 674（87.42） 97（12.58） Titer at diagnosis ≤1:4 1417 1253（88.43） 164（11.57） 3.971 0.046 ≥1:8 207 173（83.57） 34（16.43） Abnormality during pregnancy Yes 220 163（74.09） 57（25.91） 44.724 <0.001 No 1404 1263（89.96） 141（10.04） Titer before delivery ≤1:4 1171 1051（10.25） 120（10.25） 20.617 <0.001 ≥1:8 156 133（85.26） 23（14.74） Negative 227 190（83.70） 37（16.30） Unknown 70 52（74.29） 18（25.71） Initiation of treatment First/second trimester 1096 974（88.87） 122（11.13） 10.765 0.005 Third trimester 162 148（91.36） 14（8.64） Untreated 366 304（83.06） 62（16.94） Standardized treatment Yes 907 813（89.64） 94（10.36） 6.414 0.011 No 717 613（85.50） 104（14.50） Multivariate logistic regression analysis between the APOs and non-APOS group in pregnancy syphilis To further determine the factors influencing the adverse pregnancy outcomes in the women infected with syphilis, multivariate logistic regression analysis was performed, and the variables with differences ( P <0.05) in univariate analysis (Table 1) were included in the multivariate logistic regression model. Logistic regression analysis revealed that age, titer before delivery, and syphilis treatment status were associated with APOs (Table 2). Compared with the aged 20-35 years, the women less than 20 years old were more likely to have APOs (OR: 1.911, 95%CI:1.077~3.392). Those with titer negative or unknown had a higher risk than those with titer ≤1:4, with an OR of 2.727(95%CI:1.531~4.858), and 1.792(95%CI:1.194~2.688), respectively. Women with non-standardized treatment had a greater risk of APOs than those with standardized treatment (OR:1.448, 95%CI:1.064~1.971)(Figure 1). Table 2 Multivariate analysis of syphilis-infected pregnant women’s characteristics and APOs (n = 1624) Characteristic β value SE Wald value P value OR 95%CI Age，years 20~35 ≤20 0.648 0.293 4.897 0.027 1.911 1.077~3.392 ≥35 0.32 0.168 3.619 0.057 1.377 0.99~1.914 Titer before delivery ≤1:4 ≥1:8 0.372 0.25 2.214 0.137 1.451 0.889~2.370 Negative 1.003 0.294 11.609 0.001 2.727 1.531~4.858 Unknown 0.583 0.207 7.944 0.005 1.792 1.194~2.688 Syphilis treatment status Standardized treatment Non-Standardized treatment 0.37 0.157 5.543 0.019 1.448 1.064~1.971 Discussion In response to the global call for the elimination of mother-to-child transmission, China incorporated syphilis and hepatitis B into its elimination programs in 2010, launching a nationwide initiative to prevent the transmission of HIV, syphilis, and hepatitis B from mother to child. Research indicates that the proportion of pregnant women with syphilis in China rose from 35.89% in 2016 to 51.37% in 2019[4], presenting a significant health concern that impacts maternal childbirth processes and neonatal health. In 2017, several provinces in China took the lead in initiating and implementing programs aimed at eliminating mother-to-child transmission of HIV, syphilis, and hepatitis B. However, the scope of service coverage and the measures provided varied among provinces, revealing existing gaps in meeting the evaluation indicators for syphilis elimination. Current research on pregnant women with syphilis infection in China primarily focuses on trends in maternal testing and the incidence of congenital syphilis[15,17]. Notably, in remote and underdeveloped regions of China, there is a lack of research concerning adverse pregnancy outcomes associated with syphilis infection in pregnant women. Consequently, this study analyzes the risk factors for adverse pregnancy outcomes caused by syphilis infection in pregnant women in Nanning, Guangxi, from 2016 to 2020, thereby providing a scientific basis for reducing the incidence of such outcomes in this region. Between 2016 and 2020, a total of 198 pregnant women with syphilis experienced adverse pregnancy outcomes (APOs) in Nanning, Guangxi, with an APOs incidence rate of 12.19%. The incidence rate of APOs remained stable over the years, showing no notable trend of change and consistent with the APOs incidence levels observed in other provinces in China[18,19]. In this study, the average gestational week of syphilis was diagnosed among pregnant women with syphilis infection was 15 weeks, and 57.14% of these pregnant women had a history of syphilis infection, which is higher than the findings of studies conducted in other provinces in China[20]. Pregnant women with syphilis infection can pose a risk of transmitting Treponema pallidum to their fetuses at any stage during pregnancy, potentially leading to adverse pregnancy outcomes or congenital syphilis cases. According to the WHO survey on eliminating mother-to-child transmission, the primary period for mother-to-child transmission among pregnant women with syphilis infection is between the 16th and 28th weeks of gestation. Additionally, early pregnancy complicated with active syphilis can also contribute to congenital syphilis[8]. Therefore, the timing of syphilis treatment during pregnancy is crucial, as it significantly influence the intervention outcome[21,22]. The implementation plan for preventing mother-to-child transmission in China proposes that pregnant women with syphilis infection should be treated immediately upon diagnosis and regularly monitored for non-treponemal titers. Furthermore, standardized treatment holds significant public health importance in preventing adverse pregnancy outcomes and congenital syphilis. In this study, we found that pregnant women with syphilis infection had an increased risk of adverse pregnancy outcomes APOs in the ≤20 years and >35 years age groups , and divorced or widowed pregnant women also had a higher incidence of APOs, which is similar with other studies[23], suggesting that factors such as low reproductive health awareness, inadequate personal protection consciousness, and limited access to services aimed at preventing mother-to-child transmission of syphilis may contribute to this elevated risk. Recently, a multi-faceted intervention conducted in sub-Saharan Africa has demonstrated that behavioral interventions and the provision of supplies can enable over 95% of women to receive syphilis screening and treatment. Strengthening health education and health promotion among high-risk populations is a crucial measure to reduce the incidence of APOs due to syphilis infection among pregnant women[24]. Research has found that unmarried pregnant women with syphilis infection have a significantly increased risk of APOs[25], which is consistent with our findings. This may be attributed to the fact that unmarried pregnant women may not receive timely testing and standardized treatment during pregnancy, have unstable family financial situations, or lack support from family members, all of which contribute to a higher risk of APOs. It is recommended to strengthen monitoring of women of childbearing age, promptly identify pregnant women, and provide them with standardized antenatal care services. Additionally, enhancing health education for women of childbearing age and increasing their awareness of healthcare and service utilization are important measures to reduce the risk of APOs among these women. Previous studies have shown that an unknown or non-treponemal titer greater than 1:8 heightens the risk of APOs[26], which is consistent with our findings. However, our study uncovered an intriguing issue: pregnant women with syphilis infection who had negative non-treponemal titers before delivery also exhibited a high incidence of APOs. This found can be attributed to the pivotal window for mother-to-child transmission of syphilis, which occurs between the 16th and 28th weeks of gestation. Some pregnant women with syphilis infection may have missed this optimal treatment window due to delayed syphilis screening or a lack of standardized treatment during pregnancy. Our study underscores that non-standardized treatment significantly elevates the risk of APOs. Therefore, timely syphilis screening for all pregnant women during early pregnant stage and prompt initiation of anti-syphilis treatment are crucial measures to reduce the occurrence of APOs. Research has found that early syphilis treatment during pregnancy leads to a greater likelihood of a decrease or conversion to negativity in non-treponemal titers among pregnant women with syphilis infection, thereby reducing the risk of mother-to-child transmission of syphilis or APOs. The updated guidelines from the World Health Organization also recommend initiating anti-syphilis treatment in early pregnancy for pregnant women with syphilis infection to reduce the risk of APOs. Consequently, future research should focus on investigating the factors that influence pregnant women with syphilis infection to receive anti-syphilis treatment and developing corresponding intervention strategies to improve the timeliness and adherence to treatment[27,29]. Our study has several advantages. First, this is a multicenter study, with samples from almost all medical institutions in Nanning, Guangxi, covering almost all of pregnant women infected with syphilis in Nannign, Guangxi during 2016-2020. Second, this study is a hospital-based study. Most of the data came from medical records, which are accurate and reliable. Third, the sample size is relatively large, facilitating statistical analysis. Meanwhile, this study also has several limitations. Firstly, the subjects only enrolled in this study were pregnant women with positive syphilis-specific antibodies and non-specific antibodies, and did not conduct a comparative analysis of pregnant women with syphilis-specific antibodies alone or negative. Additionally, the study did not include information on syphilis infection and treatment status of the pregnant women's spouses or sexual partners, which may have had a certain impact on the study results. Declarations Acknowledgments This study was supported by funds from Self-funded research project of Western medicine of Guangxi Zhuang Autonomous Region Health Commission (NO. Z-A20241120) Compliance with ethics guidelines Yuanjun Peng, and Liangqin Mao declare that they have no conflict of interest. The studies involving human participants were reviewed and approved by the Ethics Committee of Nanning Maternal and Child Health Hospital. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Data availability The datasets generated and/or analyzed during the current study are not publicly available due confidentiality agreements involving infectious disease information, but are available from the corresponding author on reasonable request. References Lee K, You S, Li Y, Chesson H, Gift TL, Berruti AA, Hsu K, Yaesoubi R, Salomon JA, Rönn M. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiangheng","middleName":"","lastName":"Li","suffix":""},{"id":376722569,"identity":"ebe71300-a3b8-4158-9507-89f36f3bf45b","order_by":2,"name":"Mingxiao Wei","email":"","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mingxiao","middleName":"","lastName":"Wei","suffix":""},{"id":376722571,"identity":"e1bcfbf6-a03c-4ed7-acdb-941a70b381c2","order_by":3,"name":"Jinlu Wei","email":"","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinlu","middleName":"","lastName":"Wei","suffix":""},{"id":376722572,"identity":"19b12c25-5848-49da-aae5-3843a4525a7c","order_by":4,"name":"Wei Zeng","email":"","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zeng","suffix":""},{"id":376722573,"identity":"229f718d-1664-4f18-ae28-bcb60abffc83","order_by":5,"name":"Wanting Tang","email":"","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wanting","middleName":"","lastName":"Tang","suffix":""},{"id":376722575,"identity":"0147ce7c-69bf-4bec-903c-d119e1b4efbc","order_by":6,"name":"Yongquan Huang","email":"","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yongquan","middleName":"","lastName":"Huang","suffix":""},{"id":376722576,"identity":"30635676-8216-48e6-baa0-a326190d3c58","order_by":7,"name":"Xing Tao","email":"","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xing","middleName":"","lastName":"Tao","suffix":""},{"id":376722577,"identity":"a2c89202-6027-4e62-858a-e0dd9a232e4b","order_by":8,"name":"Wu Jiang","email":"","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wu","middleName":"","lastName":"Jiang","suffix":""},{"id":376722578,"identity":"d66e7ef4-60d4-43a2-b7f6-61b21b94f233","order_by":9,"name":"Liangqin Mao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIie3RsQrCMBCA4QuB1CE4HyjmFVIKxdFHOadODm6dpC7p0mfoMzg5pxQ69Q1cCr5EF8Xg4uiNgvnn++AuAYjFfjHpoX88caOS2jOJIjFptc2WeiQ2kVarct/izvKEcTpH1Fg4BIK5vH4ndgjEIh7c6uxFM94YxDQ5kg1k7UkKxyDvxTxhoQLkERh0llYeiU/soI53UWHqwiN3rFuMk5deVCdj6rqb5pKzGCw+3+E586FkYg7GYrHY3/YCDPY2zStZWjUAAAAASUVORK5CYII=","orcid":"","institution":"Nanning Maternal and Child Health Hospital","correspondingAuthor":true,"prefix":"","firstName":"Liangqin","middleName":"","lastName":"Mao","suffix":""}],"badges":[],"createdAt":"2024-10-17 08:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5281250/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5281250/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-11884-0","type":"published","date":"2025-08-05T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70038423,"identity":"940cdab1-5636-4922-b357-db0b0856ec8b","added_by":"auto","created_at":"2024-11-27 17:36:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43614,"visible":true,"origin":"","legend":"\u003cp\u003eForest map of adverse pregnancy outcomes in syphilitic pregnant women\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5281250/v1/1797ccb602c305239d215b43.png"},{"id":88814178,"identity":"0d8b540e-cd93-41d2-90e7-ff8967a60043","added_by":"auto","created_at":"2025-08-11 16:08:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":783120,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5281250/v1/d7434d22-ceef-406c-8b34-032f1a7124eb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors related to adverse pregnancy outcomes of maternal syphilis in Nanning Guangxi China 2016-2020","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSyphilis is a sexually transmitted genital ulcerative disease caused by Treponema pallidum, which could cause a range of adverse health outcome in the adults, pregnant women and infants. For instance, syphilis not only diminishes the quality and longevity of life but also manifests with an array of symptoms during its early stages, including sores, skin rashes, fever, fatigue, and adverse pregnancy outcomes among pregnant women[1]. Adverse pregnancy outcomes encompass preterm birth, stillbirth, and congenital syphilis. The clinical manifestations of congenital syphilis include rhinitis, periostitis or osteochondritis, hepatitis, pneumonitis, meningitis, hematologic derangements, as well as symptoms such as rash, fever, and failure to thrive[2,3]. Recent studies have revealed an alarming trend of escalating syphilis infections among pregnant women, with the prevalence of primary and secondary syphilis among females soaring by 172%, paralleled by a 185% increase in congenital syphilis cases between 2014 and 2018 in the United States. The same, the reported incidence of pregnant women infected with syphilis increased by 43% from 2016 to 2019. Certain studies also showed that the incidence of adverse pregnancy outcomes among pregnant women infected with syphilis in China has also significantly increased than those without syphilis[4,6].\u003c/p\u003e\n\u003cp\u003eFollowing rationale and strategy for action the global elimination of congenital syphilis was advocated in 2007, World Health Organization(WHO) launched the Global Initiative to Eliminate Mother-to-child Transmission of Syphilis and HIV (EMTCT) and the Global Guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis in 2014[7,8]. However, the burden of morbidity and mortality due to congenital syphilis is still high, there are 8 million adults infected with syphilis and 700 thousand congenital syphilis cases in 2022, underscoring the immense challenge in eradicating mother-to-child transmission of syphilis[9]. In response, the Ministry of Health of China established the integrated programmer for Prevention of Mother-to-child Transmission (PMTCT) of HIV, syphilis, and HBV in 2010[10], which aimed to prevent mother-to-child transmission by providing free testing counselling, and treatment services for women infected with syphilis. Current research on PWTCT has indicated that antenatal testing proportion was increased from 70.7% in 2012 to 94.4% in 2016 for syphilis in China, but, those pregnant women infected with syphilis did not received maternal standardized or any treatment, higher elevated non-treponema titre at diagnosis or before delivery were heightened risk factors for adverse pregnancy outcomes[11,13].\u003c/p\u003e\n\u003cp\u003eGuangxi Zhuang Autonomous Region is located in the southern coastal area of China, where economic development lags behind. The burden of syphilis infection among pregnant women in Guangxi is serious. Research indicates that the average incidence of syphilis among pregnant women in Guangxi was 0.17%, while the positive rate of syphilis at delivery was 0.67% from 2011 to 2016[14]. This study aims to explore the relevant factors associated with syphilis infection among pregnant in Nanning, Guangxi, from 2016 to 2020, and their impact on pregnancy outcomes, and then provide scientific evidence for further improving the standardized treatment and therapeutic outcomes of syphilis infections, thereby reducing adverse pregnancy outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregnant women infected with syphilis reported in Nanning city, Guangxi from 2016 \u0026ndash; 2020 were selected as the study population from the Prevention of mother-to-child transmission of Syphilis Management Information System (PMTCT). The inclusion criteria for this study were (1) positive serological antigen for both treponemal and non-treponemal in the pregnancy, (2)singleton pregnancy, (3)gestational age at delivery\u0026nbsp;\u0026ge;28 weeks. The exclusion criteria were (1) severe complication, (2) no clear pregnancy outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data of pregnant women infected with syphilis was collected through the registration card for pregnant women infected with syphilis and the registration card for pregnant women and their newborns born with syphilis. The data was reviewed by the country and municipal level and reported through the Management information System for the Prevention of mother-to-child transmission of syphilis. The data collected included socio-demographic characteristics, pregnancy history, infection status, receiving services for the prevention of mother-to-child transmission of syphilis, pregnancy and delivery outcomes, and infection status of their husbands/sexual partners.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAPOs included stillbirth, preterm or low-birth-weight infants, death within 7 days, neonatal death, neonatal asphyxia, neonatal pulmonary inflammation, birth defect, or neonatal congenital syphilis. The standardized treatment meant the application of complete full and sufficient penicillin treatment, and the treatment was completed within 1 month before delivery according to the Prevention of Mother-to-child Transmission of HIV, Syphilis and Hepatitis B implementation plan. The untreated or non-standardized group meant that pregnant women infected with syphilis had not received any treatment or received treatment but were not implemented for syphilis. \u0026nbsp; When the results of both the treponema pallidum antigen serum test and non-treponema pallidum antigen serum test were positive, pregnant women were diagnosed with syphilis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using R software (version 4.04) and IBM SPSS Statistics (version 26).\u0026nbsp;Univariate and multivariate logistics regression models were used to analyze the factors influencing the outcome of pregnancy. The influencing factors of adverse pregnancy outcomes of maternal syphilis were firstly analyzed by the univariate analysis to determine whether independent variables such as demographic characteristics, clinical characteristics, syphilis treatment status, the titer at diagnosis, and the titer before delivery were independently related to APOs., and then the variables with differences (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05) were included in the multivariate logistic regression model. Binary logistic stepwise regression was used in multivariate analysis, with the inclusion criterion \u0026alpha; = 0.05 and exclusion criterion \u0026alpha; = 0.10. Both univariate and multivariate analyses were performed using SPSS22.0 software. P values \u0026lt; 0.05 were considered statistically significant. The OR and 95%CI were compared between the APOs group and the non-APOs groups. All the comparisons were two-sided, and the \u003cem\u003eP\u003c/em\u003e-value of \u0026lt; 0.05 was considered significant.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographics characteristics and the univariate analysis of adverse pregnancy outcomes of maternal syphilis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in\u0026nbsp;Table 1, a total of 1624 pregnant women with syphilis were enrolled in this study, including 1426 pregnant women without APOs (87.81%) and 198 pregnant women with APOs (12.19%). Their average age was 31.46 \u0026plusmn; 6.08 years. The median gestational age at which they were diagnosed with syphilis was 15 weeks. The majority of these women were first married, accounting for 77.03% (1251) of the total, with 11.02% (179), 10.59(172), and 1.35(22) being remarried, cohabiting, and divorced or Widowed, respectively. Among all 1624 pregnant women with syphilis, infected women of Zhuang ethnicity accounted for 53.08% (862), and 39.16% (636) were of Han nationality. Of these, 57.14% (928) had a history of syphilis infection, and only 20.26% (326) had a history of APOs with their child born in the past.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate analysis of factors affecting APOs in women infected with syphilis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate analysis indicated that, between maternal syphilis with and without adverse pregnancy outcomes, there was no significant difference in the distribution of Ethnicity, Education, Occupation, the number of Gravidity and Parity, Syphilis infection history, etc. (Table 1). (all \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). While there was a significant difference (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05) in Age, Marital status, Titer at diagnosis, Abnormality during pregnancy, Titer before delivery, Initiation of treatment, and Standardized treatment (Table 1). The incidence of the APOs was the lowest in the 20~35-year group (10.68%) and the highest in the \u0026le;20-year group (18.89%). Compared with women in the First married group, the Divorced or Widowed women had a higher incidence rate of APOs. Significant differences in Titer at diagnosis or before delivery group, the high titer 1:8 and unknown titer had a higher incidence rate of APOs. In addition, more people in the APOs group were untreated or had a non-standardized treatment than in the non-APOs group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e Epidemiological characteristics between the maternal syphilis with and without adverse pregnancy outcomes(n=1624)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eWithout APOs\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003eWith APOs\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026le; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e73(81.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e17(18.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e8.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.016\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e20~35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e1086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e970(89.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e116(10.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026ge;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e383(85.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e65(14.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eHan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e554（87.11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e82（12.89）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.659\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eZhuang\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e761（88.97）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e101（11.72）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e121（88.97）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e15（11.03）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003ePrimary School or lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e173（88.27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e23（11.73）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e3.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.530\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eJunior school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e773（86.56）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e120（13.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eSenior school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e250（89.61）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e29（10.39）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eCollege or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e141（89.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e16（10.19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e89（89.90）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e10（10.10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eFarmer or Peasant workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e694（88.41）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e91（11.59）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e0.780\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.677\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eHousekeeping or unemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e405（86.72）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e62（13.28）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e327（87.90）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e45（12.10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eFirst married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e1251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e1114（89.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e137（10.98）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e9.670\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.022\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eDivorced or Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e18（81.82）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e4（18.18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e140（81.40）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e32（18.60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eRemarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e154（86.03）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e25（13.97）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e194（85.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e32（14.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e2.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.563\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e440\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e385（87.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e55（12.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e376（89.52）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e44（10.48）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026ge;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e471（87.55）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e67（12.45）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e308（85.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e54（14.92）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e6.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.082\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e642（87.82）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e89（12.18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e354（91.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e35（9.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e122（85.92）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e20（14.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003ePrevious with APOs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e279（84.80）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e50（15.20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e3.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.062\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e1295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e1147（88.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e148（11.43）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 37.0861%;\"\u003e\n \u003cp\u003eSyphilis infection history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e825（88.90）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e103（11.10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e2.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.120\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e601（86.35）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e95（13.65）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 37.0861%;\"\u003e\n \u003cp\u003eHusband/partner infection status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eInfected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e74（88.10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e10（11.90）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.976\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eUninfected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e351（88.19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e47（11.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e327（88.14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e44（11.86）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eUndetected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e674（87.42）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e97（12.58）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eTiter at diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026le;1:4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e1417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e1253（88.43）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e164（11.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e3.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.046\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026ge;1:8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e173（83.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e34（16.43）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 37.0861%;\"\u003e\n \u003cp\u003eAbnormality during pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e163（74.09）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e57（25.91）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e44.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e1404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e1263（89.96）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e141（10.04）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eTiter before delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026le;1:4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e1171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e1051（10.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e120（10.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e20.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003e\u0026ge;1:8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e133（85.26）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e23（14.74）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e190（83.70）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e37（16.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e52（74.29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e18（25.71）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eInitiation of treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eFirst/second trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e1096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e974（88.87）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e122（11.13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e10.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.005\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eThird trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e148（91.36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e14（8.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eUntreated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e304（83.06）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e62（16.94）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 37.0861%;\"\u003e\n \u003cp\u003eStandardized treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e813（89.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e94（10.36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e6.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e0.011\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.8278%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1987%;\"\u003e\n \u003cp\u003e613（85.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5497%;\"\u003e\n \u003cp\u003e104（14.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.4106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.755%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate logistic regression analysis between the APOs and non-APOS group in pregnancy syphilis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further determine the factors influencing the\u0026nbsp;adverse pregnancy outcomes\u0026nbsp;in the women infected with syphilis, multivariate logistic regression analysis was performed, and the variables with differences (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05) in univariate analysis (Table 1) were included in the multivariate logistic regression model. Logistic regression analysis revealed that age, titer before delivery, and syphilis treatment status were associated with APOs (Table 2). Compared with the aged 20-35 years, the women less than 20 years old were more likely to have APOs (OR: 1.911, 95%CI:1.077~3.392). Those with titer negative or unknown had a higher risk than those with titer \u0026le;1:4, with an OR of 2.727(95%CI:1.531~4.858), and 1.792(95%CI:1.194~2.688), respectively. Women with non-standardized treatment had a greater risk of APOs than those with standardized treatment (OR:1.448, 95%CI:1.064~1.971)(Figure 1).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2\u0026nbsp;Multivariate analysis of syphilis-infected pregnant women\u0026rsquo;s characteristics and APOs (n = 1624)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026beta; value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eWald value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003eAge，years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003e20~35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003e\u0026le;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e4.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e0.027\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e1.911\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e1.077~3.392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003e\u0026ge;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e3.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e0.057\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e1.377\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e0.99~1.914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003eTiter before delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003e\u0026le;1:4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003e\u0026ge;1:8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e2.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e1.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e0.889~2.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e11.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e2.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e1.531~4.858\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e7.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e1.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e1.194~2.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 37.1048%;\"\u003e\n \u003cp\u003eSyphilis treatment status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003eStandardized treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.9567%;\"\u003e\n \u003cp\u003eNon-Standardized treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1481%;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.9734%;\"\u003e\n \u003cp\u003e5.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3145%;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e1.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3045%;\"\u003e\n \u003cp\u003e1.064~1.971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn response to the global call for the elimination of mother-to-child transmission, China incorporated syphilis and hepatitis B into its elimination programs in 2010, launching a nationwide initiative to prevent the transmission of HIV, syphilis, and hepatitis B from mother to child. Research indicates that the proportion of pregnant women with syphilis in China rose from 35.89% in 2016 to 51.37% in 2019[4], presenting a significant health concern that impacts maternal childbirth processes and neonatal health. In 2017, several provinces in China took the lead in initiating and implementing programs aimed at eliminating mother-to-child transmission of HIV, syphilis, and hepatitis B. However, the scope of service coverage and the measures provided varied among provinces, revealing existing gaps in meeting the evaluation indicators for syphilis elimination. Current research on pregnant women with syphilis infection in China primarily focuses on trends in maternal testing and the incidence of congenital syphilis[15,17]. Notably, in remote and underdeveloped regions of China, there is a lack of research concerning adverse pregnancy outcomes associated with syphilis infection in pregnant women. Consequently, this study analyzes the risk factors for adverse pregnancy outcomes caused by syphilis infection in pregnant women in Nanning, Guangxi, from 2016 to 2020, thereby providing a scientific basis for reducing the incidence of such outcomes in this region.\u003c/p\u003e\n\u003cp\u003eBetween 2016 and 2020, a total of 198 pregnant women with syphilis experienced adverse pregnancy outcomes (APOs) in Nanning, Guangxi, with an APOs incidence rate of 12.19%. The incidence rate of APOs remained stable over the years, showing no notable trend of change and consistent with the APOs incidence levels observed in other provinces in China[18,19]. In this study, the average gestational week of syphilis was diagnosed among pregnant women with syphilis infection was 15 weeks, and 57.14% of these pregnant women had a history of syphilis infection, which is higher than the findings of studies conducted in other provinces in China[20]. Pregnant women with syphilis infection can pose a risk of transmitting Treponema pallidum to their fetuses at any stage during pregnancy, potentially leading to adverse pregnancy outcomes or congenital syphilis cases. According to the WHO survey on eliminating mother-to-child transmission, the primary period for mother-to-child transmission among pregnant women with syphilis infection is between the 16th and 28th weeks of gestation. Additionally, early pregnancy complicated with active syphilis can also contribute to congenital syphilis[8]. Therefore, the timing of syphilis treatment during pregnancy is crucial, as it significantly influence the intervention outcome[21,22]. The implementation plan for preventing mother-to-child transmission in China proposes that pregnant women with syphilis infection should be treated immediately upon diagnosis and regularly monitored for non-treponemal titers. Furthermore, standardized treatment holds significant public health importance in preventing adverse pregnancy outcomes and congenital syphilis.\u003c/p\u003e\n\u003cp\u003eIn this study, we found that pregnant women with syphilis infection had an increased risk of adverse pregnancy outcomes APOs in the \u0026le;20 years and \u0026gt;35 years age groups , and divorced or widowed pregnant women also had a higher incidence of APOs, which is similar with other studies[23], suggesting that factors such as low reproductive health awareness, inadequate personal protection consciousness, and limited access to services aimed at preventing mother-to-child transmission of syphilis may contribute to this elevated risk. Recently, a multi-faceted intervention conducted in sub-Saharan Africa has demonstrated that behavioral interventions and the provision of supplies can enable over 95% of women to receive syphilis screening and treatment. Strengthening health education and health promotion among high-risk populations is a crucial measure to reduce the incidence of APOs due to syphilis infection among pregnant women[24]. Research has found that unmarried pregnant women with syphilis infection have a significantly increased risk of APOs[25], which is consistent with our findings. This may be attributed to the fact that unmarried pregnant women may not receive timely testing and standardized treatment during pregnancy, have unstable family financial situations, or lack support from family members, all of which contribute to a higher risk of APOs. It is recommended to strengthen monitoring of women of childbearing age, promptly identify pregnant women, and provide them with standardized antenatal care services. Additionally, enhancing health education for women of childbearing age and increasing their awareness of healthcare and service utilization are important measures to reduce the risk of APOs among these women.\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that an unknown or non-treponemal titer greater than 1:8 heightens the risk of APOs[26], which is consistent with our findings. However, our study uncovered an intriguing issue: pregnant women with syphilis infection who had negative non-treponemal titers before delivery also exhibited a high incidence of APOs. This found can be attributed to the pivotal window for mother-to-child transmission of syphilis, which occurs between the 16th and 28th weeks of gestation. Some pregnant women with syphilis infection may have missed this optimal treatment window due to delayed syphilis screening or a lack of standardized treatment during pregnancy. Our study underscores that non-standardized treatment significantly elevates the risk of APOs. Therefore, timely syphilis screening for all pregnant women during early pregnant stage and prompt initiation of anti-syphilis treatment are crucial measures to reduce the occurrence of APOs. Research has found that early syphilis treatment during pregnancy leads to a greater likelihood of a decrease or conversion to negativity in non-treponemal titers among pregnant women with syphilis infection, thereby reducing the risk of mother-to-child transmission of syphilis or APOs. The updated guidelines from the World Health Organization also recommend initiating anti-syphilis treatment in early pregnancy for pregnant women with syphilis infection to reduce the risk of APOs. Consequently, future research should focus on investigating the factors that influence pregnant women with syphilis infection to receive anti-syphilis treatment and developing corresponding intervention strategies to improve the timeliness and adherence to treatment[27,29].\u003c/p\u003e\n\u003cp\u003eOur study has several advantages. First, this is a multicenter study, with samples from almost all medical institutions in Nanning, Guangxi, covering almost all of pregnant women infected with syphilis in Nannign, Guangxi during 2016-2020. Second, this study is a hospital-based study. Most of the data came from medical records, which are accurate and reliable. Third, the sample size is relatively large, facilitating statistical analysis. Meanwhile, this study also has several limitations. Firstly, the subjects only enrolled in this study were pregnant women with positive syphilis-specific antibodies and non-specific antibodies, and did not conduct a comparative analysis of pregnant women with syphilis-specific antibodies alone or negative. Additionally, the study did not include information on syphilis infection and treatment status of the pregnant women\u0026apos;s spouses or sexual partners, which may have had a certain impact on the study results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by funds from Self-funded research project of Western medicine of Guangxi Zhuang Autonomous Region Health Commission (NO. Z-A20241120)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with ethics guidelines\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYuanjun Peng, and Liangqin Mao declare that they have no conflict of interest. The studies involving human participants were reviewed and approved by the Ethics Committee of Nanning Maternal and Child Health Hospital. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due confidentiality agreements involving infectious disease information, but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLee K, You S, Li Y, Chesson H, Gift TL, Berruti AA, Hsu K, Yaesoubi R, Salomon JA, R\u0026ouml;nn M. Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis Acquired in the United States in 2018. 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(Cited 2024 September 23)\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Maternal syphilis, Pregnancy, Adverse pregnancy outcome, Influencing factors","lastPublishedDoi":"10.21203/rs.3.rs-5281250/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5281250/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Syphilis is a relatively common sexually transmitted disease worldwide. Maternal syphilis not only severely affects the quality of life of pregnant women but also leads to various adverse pregnancy outcomes (APOs) and even congenital syphilis. This study aimed to investigate the association between maternal syphilis infection and adverse pregnancy outcomes in offspring. Multivariate logistic regression model was used to analyze the associations between maternal syphilis infection and APOs, and to explore its stability through subgroup analysis. 1624 pregnant women with syphilis in Nanning, Guangxi during 2016-2020 were selected as participants. The multivariate logistic regression analysis revealed that being under 20 years of age (OR: 1.911, 95% CI: 1.077-3.392), having an unknown titer prior to delivery (OR: 1.792, 95% CI: 1.194-2.688), and undergoing non-standardized treatment (OR: 1.448, 95% CI: 1.064-1.971) emerged as significant risk factors. The implementation of integrated prevention measures such as early syphilis screening, eugenics assessment and standardized treatment and follow-up of pregnant syphilis are of great significance in reducing the incidence of APOs for pregnant women infected with syphilis.","manuscriptTitle":"Factors related to adverse pregnancy outcomes of maternal syphilis in Nanning Guangxi China 2016-2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-27 17:36:31","doi":"10.21203/rs.3.rs-5281250/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-08T06:46:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-07T11:20:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123796539021308116246548016671818776072","date":"2025-05-03T07:12:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-28T03:16:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311029672162685098396121936200333926455","date":"2025-04-19T01:54:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305871896517815352011904902382257269037","date":"2025-03-24T14:39:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286324313522072280117330687793776919930","date":"2025-03-10T18:36:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84452800445162016719996999141525765585","date":"2025-01-28T04:24:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224501326120950890583009205348355972949","date":"2025-01-27T04:10:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-27T03:53:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-27T03:44:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-04T10:40:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-01T06:51:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-10-17T08:46:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eccebc2b-3ca0-4318-bb22-d53cb08abc86","owner":[],"postedDate":"November 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":40101301,"name":"Health sciences/Diseases"},{"id":40101302,"name":"Health sciences/Health care"},{"id":40101303,"name":"Health sciences/Medical research"},{"id":40101304,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-08-11T16:02:47+00:00","versionOfRecord":{"articleIdentity":"rs-5281250","link":"https://doi.org/10.1038/s41598-025-11884-0","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-08-05 15:57:48","publishedOnDateReadable":"August 5th, 2025"},"versionCreatedAt":"2024-11-27 17:36:31","video":"","vorDoi":"10.1038/s41598-025-11884-0","vorDoiUrl":"https://doi.org/10.1038/s41598-025-11884-0","workflowStages":[]},"version":"v1","identity":"rs-5281250","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5281250","identity":"rs-5281250","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}