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Group B Strep

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expecting bellyGroup B streptococcus (also known as GBS, group B strep, or baby strep) is a common bacteria found in the vagina and rectum. GBS infection can be passed from mother to baby during childbirth and can cause serious illness and/or death in newborns. If the bacteria invade the womb during pregnancy, miscarriage, stillbirth and preterm delivery are possible. Knowing your GBS status and getting proper treatment can protect your newborn.

The Center for Disease Control (CDC) estimates that approximately 25% of women are colonized with GBS in the vagina or rectum. A pregnant mother may be unaware that she is a carrier of the bacteria. If the expecting mother is a carrier and does not have an infection, she will not have any symptoms of infection. Group B strep is not a sexually transmitted disease and is a naturally occurring bacteria in the body that comes and goes.

GBS infection can be very serious in newborns and has been a leading cause of neonatal morbidity and mortality. According to the CDC, group B strep is the leading cause of meningitis (infection of the fluid and lining around the brain) and sepsis (infection of the blood) in a newborn’s first week of life (early-onset disease). It’s estimated that approximately 1,200 babies in the U.S. less than one week old get early-onset group B strep disease each year1
 
Since GBS is a common bacterium and can come and go throughout pregnancy. The CDC recommends testing for group B strep between the 35th and 37th week of pregnancy. Testing is done by taking a culture swab of the expectant mother’s vagina and rectum. You should be tested for group B strep each pregnancy.
 
If your culture comes back positive for group B strep, it is important to let your healthcare providers know when you go into labor. Treatment for GBS includes intravenous (in the vein) antibiotics at least four hours before your baby is born. The antibiotic of choice is Penicillin. If you are allergic to Penicillin, there are other antibiotic options (such as Cefazolin). 
 
Since the antibiotic needs to be given 4 hours prior to delivery, it is important to get to the hospital when your water breaks or when you go into labor. Group B strep bacteria can grow back quickly; therefore, antibiotics are only helpful during labor and cannot be taken before the onset of labor. If a cesarean delivery is performed before the onset of labor on a woman with intact amniotic membranes, the risk for early-onset GBS disease among full-term infants is extremely low and treatment is not indicated.
 
Just because you are group B strep positive does not mean your child will become ill. According to the CDC, 1 in 200 babies will become ill if treatment is not initiated. With appropriate antibiotic treatment during labor, only 1 in 4,000 will become ill. 
 
The following criteria all necessitate antibiotic treatment during labor:
 
    1.  Mother who has a positive GBS vaginal-rectal screening culture within 5 weeks of labor onset.
 
    2.  Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) and one of the following risk factors: 
  • Delivery at <37 weeks' gestation, 
  • Rupture of membranes (water breaks) for ≥18 hours, or 
  • Temperature of ≥100.4°F (38.0°C).
    3.  GBS bacteria present in urine (bacteriuria) during current pregnancy. 
 
    4.  Any pregnant woman who had a baby with group B strep disease in the past, or who has had a bladder (urinary tract) infection during this pregnancy caused by group B strep.
 
GBS Disease in Newborns
 
Early-onset disease occurs in the first week of life and most commonly causes sepsis, pneumonia (infection in the lungs), and sometimes meningitis. Infants with early-onset GBS disease generally present with breathing difficulties, lethargy, poor feeding and/or unstable temperature within the first two days of life. 
 
Late-onset disease occurs from the first week through the third month of life and is more common among babies born prematurely (< 37 weeks). Meningitis is more common with late-onset group B strep disease than with early-onset.
 
Antibiotics given during labor are very effective at preventing transmission of bacteria to infant. Mom’s who are GBS can still breastfeed without negative effects on their baby.
 
The American Academy of Pediatrics recommends the following for infants born to GBS positive mothers:
  • Any newborn with signs of sepsis should receive a full diagnostic evaluation and antibiotic therapy. “Full diagnostic evaluation” includes:
    • a blood culture,
    • a CBC (complete blood count),
    • a chest x-ray (if infant is having respiratory issues), 
    • a lumbar puncture (spinal tap). 
  • Well-appearing newborns whose mothers had suspected chorioamnionitis (infection of the amniotic sac) should undergo a limited evaluation and receive antibiotics. “Limited evaluation” includes
    • a blood culture
    • a CBC including  
  • Well-appearing infants whose mothers did not have chorioamnionitis and no indication for antibiotic therapy during labor should receive routine care.
  • Well-appearing infants of any gestational age whose mother received adequate antibiotics during labor (≥4 hours of penicillin, ampicillin, or cefazolin before delivery) should be observed for at least 48 hours. No routine diagnostic testing is needed. Babies can be discharged home as early as 24 hours after delivery, assuming that other discharge criteria have been met, able to access medical care, and parent is able to comply with discharge instructions. If discharged home at 24 hours of life, it is recommended that your baby follows up with his/her primary care provider within 48 to 72 hours. 
  • For well-appearing infants born to mothers who met criteria to receive antibiotics during labor but did not receive or did not receive adequate antibiotics (<4 hours before delivery or with an inappropriate antibiotic) during labor,:
    • If the infant is well-appearing and ≥37 weeks and the duration of membrane rupture before delivery is less than 18 hours, then the infant should be observed for at least 48 hours. No routine diagnostic testing is recommended. 
    • If the infant is well-appearing and is either premature (<37 weeks) or membrane ruptures for 18 or more hours before delivery, then the infant should undergo a limited evaluation and observation for at least 48 hours.
Be sure to discuss group B strep with your healthcare provider and get screened between your 35th-37th week of pregnancy.
 
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Sources:
1. American Academy of Pediatrics. Policy Statement Recommendations for the Prevention of Perinatal Group B Streptococcal (GBS) Disease. PEDIATRICS Vol. 128 No. 3 September 1, 2011. Published online August 1, 2011 
CDC. MMWR Prevention of Perinatal Group B Streptococcal Disease Revised Guidelines from CDC, 2010. November 19, 2010 / Vol. 59 / No. RR-10
CDC: Group B Strep 

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