Prevalência da sífilis congênita em recém-nascido no contexto mundial: revisão sistemática.

Abstract

Qualified perinatal care consists of providing care to pregnant women from pregnancy to delivery, as a way of promoting a healthy pregnancy. However, ensuring a healthy pregnancy comes up against maternal morbidities, such as syphilis in pregnant women, in addition to the risk of vertical transmission to the fetus. Objective: Estimate the prevalence of congenital syphilis in newborns in the global context. Method: This is a systematic review with meta-analysis. To construct the guiding question: “What is the prevalence of congenital syphilis in the global context?” I use the acronym PECOT (Population, Exposure, Comparator, Outcomes, Study Type). The search took place in the following databases: Embase, PubMed, Scopus, Ebsco, Web of Science, Latin American and Caribbean Literature in Health Sciences. As a search strategy, a combination of descriptors indexed in Medical Subject Headings was adopted: Pregnancy; Syphilis Infectious Disease Transmission, Vertical; Observational Study, intermediated by the Boolean operators “AND” and “OR”. As inclusion criteria, observational studies on the vertical transmission of gestational syphilis and the association of gestational syphilis with congenital syphilis were included. There were no language or time restrictions for selecting studies. The systematic review period was June to November 2023. The selection of articles and data extraction were carried out by two independent, blinded reviewers, using the Rayyan Intelligent Systematic Review software and based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. In assessing the quality of evidence of the included data, the Grading of Recommendations Assessment, Developing and Evaluation method was chosen, while, for the analysis of risk of bias, the Newcastle-Ottawa Scale and the checklist of Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews. The review protocol was submitted to the International Prospective Register of Systematic Reviews database, registered under number CRD 42022349359, and, as it was research data already published in a scientific database, the Ethics Committee was waived in Search. Results: In total, 6,268 studies were identified in the databases. The sample consisted of 15 studies (eight cohort studies; two case-control; five cross-sectional studies). The research took place mainly in the United States of America, Brazil and China, and from 1995 to 2022. As a diagnosis of the disease, the rapid treponemal test predominated in studies and benzathine penicillin G was the drug of choice for treatment. As an effect of transmission, the complications found in newborns were: congenital syphilis and adverse events associated with prematurity, low birth weight and fetal/neonatal mortality. The main cause of verticalization was associated with incomplete treatment of syphilis during pregnancy and late diagnosis of the disease in the third trimester. The global prevalence of congenital syphilis corresponded to 30.75% (95% CI, 0.17-0.50; I²=99%) and the prevalence of transmission showed that untreated pregnant women increased by 5.49% (95% CI, 0.59-51.31; I²= 97%) the possibility of vertical transmission. Conclusion: Despite the high number of studies identified in the databases, regardless of period and language, only 15 studies primarily contextualized the global reality of congenital syphilis and its association with gestational syphilis. However, the outcome of vertical transmission continues to be represented by the lack of treatment for gestational syphilis