Preditores da sífilis gestacional em um estado da Amazônia brasileira: um estudo de caso e controle

Abstract

Introduction: Advances in public policies aimed at maternal and child care implemented in Brazil in recent decades have not yet had an impact on reducing gestational syphilis and, especially, congenital syphilis. In Pará, there is still a high number of cases of gestational syphilis detected in childbirth and puerperium. The factors that relate to the maintenance of this context are unknown. Objective: To determine the predictors of gestational syphilis in a state in the Brazilian Amazon region. Methods: Unpaired case-control study, carried out in a public reference maternity hospital in Pará. Data were collected from November 2020 to July 2021, from the application of the form, analysis of the pregnant woman's card and medical records. Women diagnosed with syphilis during pregnancy, childbirth or puerperium were considered as cases. Controls were women without a diagnosis of syphilis in the pregnancy puerperal cycle. The response variable was the diagnosis or not of gestational syphilis, the event being considered the diagnosis of gestational syphilis in the prenatal, delivery or postpartum period. Independent variables were grouped into: a) sociodemographic; b) gynecological and obstetric by two (02) categorical variables and five (05) discrete variables; c) sexual and obstetric practices by eight (08) categorical variables; d) knowledge is composed of fifteen (15) categorical variables and e) Attitudes is composed of six (06) categorical variables. The sample size, calculated using the Kelsey method, was 204 participants, 68 cases and 136 controls. To test the main hypothesis of the study, multiple logistic regression analysis was performed. In the Bioestat 5.3® program, the chi-square test of independence, tendency and G test were applied. In the Minitab 20® program, descriptive analyzes and logistic regression were performed. Odds ratio, 95% confidence interval was calculated. P values <0.05 were considered statistically significant. Results: Among the 68 cases and 137 controls, age ranged from 15 to 41 years, mean age was 26.1 years (SD: 6.2). In the multiple logistic regression, the cases are independently associated with the lowest number of prenatal consultations (OR: 0.82; p = 0.02), history of previous STI (OR: 24.8; p = 0.00 ), spontaneous abortion (OR: 2.86; p = 0.025) and difficulty in talking with the partner about the use of sexual condoms in relationships (OR: 4.43; p = 0.00). Among the factors of knowledge and attitudes, cases were associated with knowledge about vertical transmission (OD: 0.24; p= 0.019), treatment with penicillin (OD: 0.47; p= 0.023) and on the availability of treatment in basic health units (OD: 0.14; p= 0.014). However, they are associated with the lack of knowledge about the lack of vaccine (OD: 1.94; p= 0.04). The analysis of variables related to attitudes showed an association of cases (OD: 2.40; p= 0.016) with inadequate attitude about the beginning of prenatal care. There is an increase in reactive cases from the 1st trimester to the puerperium with p < 0.0001, with the highest significant proportions of reactive cases during delivery and postpartum. Conclusion: gynecological-obstetric factors, sexual and reproductive practices and knowledge are associated with gestational syphilis. In a population with precarious socioeconomic conditions, no association of these factors was demonstrated. Actions for monitoring and evaluating prenatal care are urgent.