CLINICAL ARTICLE Gestational syphilis and stillbirth in Latin America and the Caribbean Lauren Arnesen ⁎, Gerardo Martínez, Luis Mainero, Suzanne Serruya, Pablo Durán Pan American Health Organization, Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Montevideo, Uruguay abstract article info Article history: Received 10 April 2014 Received in revised form 3 September 2014 Accepted 3 November 2014 Keywords: Caribbean Latin America Mother-to-child transmission Stillbirth Syphilis Objective: To measure the association between gestational syphilis and stillbirth in Latin America and the Caribbean. Methods: In a retrospective study, data on stillbirth and gestational syphilis extracted from the Sistema Informático Perinatal database were analyzed for deliveries in 11 countries between January 1, 2009, and December 31, 2012. Potential confounders were examined, and binary logistic regression analysis was performed to assess the association between gestational syphilis and stillbirth. Results: Among 368 151 deliveries, 3875 (1.1%) were by women with a positive syphilis test, and 1461 (0.4%) were stillbirths. Among the stillbirths, 29 (2.0%) were delivered by women with a positive syphilis test. After controlling for country, congenital anom- alies, gestational age at labor, maternal age, and previous stillbirth, gestational syphilis was significantly associ- ated with stillbirth (odds ratio 1.88, 95% confidence interval 1.25–2.83; P = 0.002). Conclusion: Gestational syphilis contributes to stillbirth in Latin America and the Caribbean. Interventions targeting gestational syphilis are highly cost-effective and should be implemented across the region. © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction WHO estimates that 1.36–2 million pregnancies are affected by syphilis every year [1–3], of which 50%–80% will result in adverse out- comes without proper treatment [2,4–6]. Prominent among these out- comes is stillbirth, which occurs in 25%–40% of cases [4–6]. Globally, syphilis is the main cause of more than 212 000 stillbirths annually [2,3,7], and, in areas with a high prevalence of syphilis, as many as half of all stillbirths can be attributed to this infection [5,8]. Worldwide, Latin America and the Caribbean (LAC) has the highest incidence of syphilis, and accounts for up to 25% of the 2 million annual cases of gestational syphilis [1,9]. The prevalence of gestational syphilis in LAC varies from 0.08% to 7.0% by country [2,10]. Every year, an esti- mated 100 000 stillbirths in the region are attributable to congenital syphilis, which is defined as a neonate delivered to a mother who was untreated or inadequately treated for syphilis during pregnancy, or a neonate with a positive syphilis test [1,10,11]. The Pan American Health Organization (PAHO) approved the Regional Elimination of Congenital Syphilis Plans of Action in 1995 and 2010, in which elimination is defined as an incidence of 0.5 or fewer cases of congenital syphilis, including stillbirths, per 1000 de- liveries [1,9,10]. Elimination of congenital syphilis is possible with proper treatment—one dose of penicillin is almost 100% effective at preventing syphilis-associated adverse outcomes in pregnancy [2,5,7, 9,12]. Moreover, the cost-effectiveness of prenatal syphilis screening and treatment has been shown repeatedly and is considered one of the most cost-effective interventions available [2,4,5,10,12]. Nevertheless, syphilis-attributable stillbirths are still occurring in LAC. There are few studies on the relationship between gestational syphilis and stillbirth in LAC. Two previous studies in the region showed that the risk of stillbirth increases with exposure to gestational syphilis: one [13] reported that women with a positive syphilis test in Jamaica have a 3.04-fold increased odds of fetal death, whereas the other [14] indicated that women with a positive syphilis test in LAC countries have a 2.41-fold higher risk of fetal death. Generally, research in LAC has focused on the prevalence of gestational syphilis and calls to action to test and treat pregnant women [14], rather than examining factors that influence the relationship between gestational syphilis and still- birth, and only one study has approached the problem at the regional level [13,15–19]. Sistema Informático Perinatal (SIP) is a PAHO/WHO database, devel- oped by the Latin American Center for Perinatology and Human Devel- opment (CLAP), which includes a set of standardized instruments designed for obstetric and neonatal health services [14]. Every entry in SIP corresponds to a birth record containing data on maternal demo- graphics; family and obstetric history; prenatal visits, delivery, and postpartum details; and discharge information for both the mother and neonate. Information is prospectively recorded at the clinic level during prenatal, delivery, and postnatal care. In addition to recording clinical data, SIP facilitates the electronic storage of information for further processing and analysis for managerial, epidemiologic, and other purposes. The primary aim of the present study was to use SIP data for deliver- ies occurring from 2009 to 2012 to measure the association between gestational syphilis and stillbirth at the regional level, with adjustments International Journal of Gynecology and Obstetrics 128 (2015) 241–245 ⁎ Corresponding author at: Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Avenue Italia # Hospital de Clinicas, Piso 16, Montevideo 11100, Uruguay. Tel.: +598 2 487 2929. E-mail address: laurenarnesen@gmail.com (L. Arnesen). http://dx.doi.org/10.1016/j.ijgo.2014.09.017 0020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo