Syphilis in pregnancy: experience from a rural aboriginal community

Syphilis in pregnancy is seldom encountered in urban Australia. This retrospective study reports on the high prevalence of syphilis and its associated complications in a group of pregnant Aboriginal women attending the Dareton Community Health Centre for antenatal care between September, 1989 and September, 1991. During this time, the centre provided antenatal care for 71 Aboriginal pregnancies and maternal syphilis was found in 20 (28%). The mean age of the women was 21.3 years (range of 14-33 years). The perinatal mortality rate was 48 per 1,000 births. All stillbirths were associated with maternal syphilis. The relative risk of stillbirth in the presence of syphilis was 4 (95% CI 2.56-6.25, p = 0.022). Prematurity was associated with maternal syphilis. The odds ratio for premature delivery was 21.5 (95% CI 2.26-2.05, p = 0.003). There was no statistical difference between the mean birth-weight and mean placental weight of term infants born to women with syphilis and women without syphilis (p = 0.35 and p = 0.31 respectively). When the placental:birth-weight ratios were considered, an apparent larger placenta was seen in association with syphilis but this was secondary to the lower birth-weights in association with prematurity. Late and poor attendance for antenatal care was a feature of all women attending this centre and not a feature associated with syphilis. The treatment and follow-up of syphilis were hindered by poor compliance.