Amy B. Triche, Boston University School of Medicine, Guilford, CT, United States; Lila Coverstone, BIDLS MassDPH, Lenoir City, TN, United States; Lauren E. Molotnikov, Massachusetts DPH DSTDP, Natick, MA, United States; Kathleen Roosevelt, Massachusetts Department of Public Health, Boston, MA, United States; Katherine K. Hsu, Boston Univ. Med. Ctr., Jamaica Plain, MA, United States; Zoon Wangu, UMass Memorial Children's Medical Center, Worcester, MA, United States
Pediatric Infectious Diseases Fellowship Graduate Boston University School of Medicine Guilford, Connecticut, United States
Background: Congenital syphilis remains an important preventable cause of neonatal morbidity and mortality in the United States despite longstanding guidelines for prenatal testing and treatment. Long-term infant outcomes following congenital syphilis exposure are not well-known.
Objective: To describe clinical outcomes (growth, developmental status, specialty referrals) from birth to age 2 years in infants born to syphilis-infected mothers.
Design/Methods: Using state public health surveillance data, we included mother-infant dyads in which mother tested positive for syphilis during pregnancy and baby was born in Massachusetts in 2015-2017. Data included maternal and infant characteristics, maternal syphilis stage and treatment, and infant outcomes (growth, development, and specialty referrals including to audiology and ophthalmology) up to age 2 years. Analyses were stratified by maternal syphilis stage and treatment adequacy as defined by U.S. Centers for Disease Control and Prevention. Differences in clinician-reported developmental delays and specialist referrals by maternal syphilis stage (secondary v. early non-primary non-secondary v. late latent) were tested using Chi-square or Fisher’s exact tests. Differences in infant growth parameters at 1 and 2 years by maternal syphilis stage were tested using ANOVA; specific comparisons between syphilis stages were made using Tukey’s tests for multiple comparisons.
Results: Of 112 eligible dyads, 40 infants were lost to follow-up; 72 dyads were included in final analysis. Of these 72 mothers, 6 had secondary, 21 had early non-primary non-secondary, and 45 had late latent syphilis. Adequate treatment was administered to 57 (79%) mothers; 3 infants with probable congenital syphilis were born to inadequately treated mothers and treated at the time of delivery. No significant differences in infant outcomes up to 2 years were identified based on adequacy of maternal treatment. Infants born to mothers with secondary syphilis (4/6, 67%) had a significantly higher rate of developmental delay (Fisher p-value=0.03) compared to mothers with early non-primary non-secondary (1/13, 8%) and late latent (7/37, 24%) syphilis. Infants born to mothers with secondary syphilis also had lower average height percentile at 1 year (26.3) compared to those born to mothers with late latent (56.5) syphilis. Height differences were no longer present at 2 years.Conclusion(s): Stage of maternal syphilis during pregnancy may have notable implications for infant growth and development, even if adequate treatment is given to both mother and infant.
