Fatores de risco para sífilis gestacional em serviço de atenção terciaria à saúde: estudo caso-controle

Abstract

Gestational syphilis is an infectious disease, transmitted vertically and is associated with several negative outcomes in pregnancy that are preventable when detected and treated early. Current recommendations for syphilis control reinforce the need to prioritize global interventions in prevention, diagnosis and treatment, especially to population groups more exposed or in vulnerable situations. This study aims to identify factors associated with syphilis in pregnant women admitted to tertiary health care institution in Paraná. An ambispective paired case-control study (ratio 1: 2) was conducted from September 2020 to October 2021. Pregnant patients hospitalized in the maternity hospital who presented reagent of Venereal Disease Research Laboratory (VDRL) tests and rapid tests (n = 93) were compared with 186 controls matched by age (± 5 years) and the same period of admission to the maternity. All pregnant patients answered a questionnaire, with sociodemographic, behavioral, prenatal health care and maternity variables. Absolute (n) and relative (%) frequencies were used for descriptive analysis of the information. The bivariate association between sociodemographic, behavioral and prenatal health care and maternity variables with syphilis was verified by the Chi-square test with Yates continuity correction. The independent variables that presented p<0.20 in the crude analyses were taken to the multivariate models of binary logistic regression. These variables were inserted in the models in a blocked way (sociodemographic, behavioral and health care variables in prenatal care and maternity) from lower to the highest p value. Only the variables remained in the adjusted model that, after consideration within the level and between levels, remained significant (p<0.05). Thus, the results of adjusted odds ratio and 95% confidence interval are presented only for the variables that made up the final model. All analyses were performed in the SPSS 25.0 program. In the results, there was a higher frequency of pregnant women living without a partner and non-white race, pregnancy before 16 years, higher number of sexual partners, higher consumption of licit and illicit drugs, and greater consumption of drugs by the sexual partner among the cases. Regarding the variables related to prenatal health care and maternity, only the history of STIs was associated, being also more frequent among cases compared to controls. In the logistic regression analysis, we identified as risk factors for gestational syphilis to be non-white (OR: 2.12; CI:1.19-3.80; p:0.001), having more than one sexual partner (OR: 3.69; CI:1.70-8.00; p:0.001); already been a smoker (OR:2.07; CI:1.07-4.01); p:0.030), smoker (OR:4.31; CI:1.55-11.98; p:0.005) and have history of STIs (OR:10.87; CI:4.04-29.27; p<0.0.01). It is concluded that sociodemographic, behavioral and care factors are associated with gestational syphilis and should be taken into account both in the management of these patients and in the formulation of women's health care policies.