Table 1 Quality assessment of evidence for treatment with at least 2.4MU penicillin for women with active syphilis in pregnancy to prevent adverse pregnancy and neonatal outcomes:
| 听 | Quality Assessment | Summary of Findings | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 听 | 听 | 听 | 听 | 听 | Directness | 听 | Treated women with active syphilis | Untreated women with active syphilis | 听 | |||
No of studies (ref) | Intervention | Design | Limitations | Consistency | Generalizability to population of interest | Generalizability to intervention of interest | GRADE of evidence | Number events | Number of births | Number events | Number of births | Effect size (95% CI) |
Stillbirths: | ||||||||||||
8 | At least 2.4MU penicillin | Observational studies | no or insufficient controlling for important potential confounding variables | Consistent | Yes | Yes | Low | 70 | 2578 | 185 | 1353 | RR= 0.18* (0.10 - 0.33) |
PerinatalMortality (stillbirth and early neonatal mortality): | ||||||||||||
2 | At least 2.4MU penicillin | Cohort studies | Both from South Africa | Consistent | Both from South Africa | Yes | Low | 39 | 952 | 19 | 233 | RR= 0.49 - 0.65 |
Neonatal Mortality (All Cause): | ||||||||||||
5 | At least 2.4MU penicillin | Observational studies | no or insufficient controlling for important potential confounding variables | Consistent | Yes | Yes | Low | 29 | 2068 | 62 | 972 | RR=0.20* (0.13 - 0.32) |
Preterm birth: | ||||||||||||
7 | At least 2.4MU penicillin | Observational studies | no or insufficient controlling for important potential confounding variables | Consistent | Yes | Yes | Low | 85 | 947 | 250 | 1012 | RR=0.36* (0.27 - 0.47) |
Congenital syphilis: | ||||||||||||
3 | At least 2.4MU penicillin | Observational studies | no or insufficient controlling for important potential confounding variables but as very specific outcome unlikely to be confounded | Consistent | Yes | Yes | Moderate | 20 | 2745 | 139 | 715 | RR=0.03* (0.02 - 0.07) |