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Group B Streptococcus in Pregnancy
Group B Streptococcus, also referred to as “Group B Strep” or “GBS”, is the most common cause of life-threatening infection in newborn babies in the UK. This is an alarming statement especially when Group B Strep infection can often be prevented.
Added 06th July, 2021
Group B Strep can affect pregnant women, young babies, the elderly and people with underlying medical conditions. However, this article will focus primarily on Group B Strep during pregnancy, looking at how it is diagnosed and how it can be prevented.
It is hoped that by increasing awareness of this condition, women who are at a higher risk of Group B Strep infection can be identified and their pregnancies managed appropriately to help prevent Group B strep infection passing to their newborn babies.
What is Group B Strep?
Group B Strep is one of many bacteria which lives in our bodies and is often found in the digestive system, vagina or rectum (bottom). It is common in both men and women and usually does not cause any harm. It is not a sexually transmitted disease and around 20-40% of women in the UK carry Group B Strep without even knowing it.
An individual may only be a carrier of Group B Strep for a short period of time and it will be unlikely to pose any risk unless the individual is pregnant when it can transfer to their baby during labour or birth.
There are two types of Group B Strep infection:
1. Early onset infection- which affects newborn babies within the first week of life (often within 24 hours of birth).
2. Late onset infection- which affects a baby within the first three months of birth.
It is worth highlighting that Group B Strep infections in a baby over three months of age is extremely rare.
What are the risks of Group B Strep infection?
Around 1 in every 1,750 newborn babies born in the UK are diagnosed with early onset Group B Strep infection.
It is worth remembering that most pregnant women who carry Group B Strep give birth to healthy babies, who do not go on to develop infection.
Group B Strep infection can in rare cases lead to a baby developing more serious problems like sepsis (infection of the blood), pneumonia (infection in the lungs), or meningitis (infection of the fluid and lining around the brain) which can cause hearing loss, loss of vision or can be fatal therefore, it is important prompt treatment is obtained.
Around 87-88% of babies diagnosed with early onset Group B Strep will make a full recovery. However, 7-8% of those diagnosed will suffer a long term physical or mental disability and sadly around 5 % will not survive.
How is Group B Step infection diagnosed?
Routine testing for Group B Strep is not routinely offered to all pregnant women in the UK but it may be found during the course of other routine tests such as urine tests or vaginal swabs.
It is a controversial issue that routine testing is not widely available in the UK as it is in other high-income countries.
The UK National Screening Committee does not recommend testing all pregnant women because:
• Many women carry the bacteria, and the majority of their babies are born safely without infection.
• Screening women in late pregnancy (35-37 weeks) cannot predict which babies will develop Group B Strep.
• The testing is not entirely accurate for instance around 4% of women who have a negative swab test result will carry Group B Strep bacteria by the time they give birth, and 13% of women who have a positive swab test result do not carry Group B Strep by the time they give birth.
• Many babies severely affected by Group B Strep are born prematurely before the suggested time for screening.
• If treatment in the form of antibiotics were given to all Group B Strep carriers, this would mean that a very large number of women would receive treatment unnecessarily.
Obviously, if you are pregnant you may be anxious about whether you carry Group B Strep and there is an option to pay privately for a swab Enriched Culture Medium (ECM) test and this should be discussed with your midwife or GP.
Who is most at risk of Group B Strep infection?
• Infection is most likely to occur in preterm babies i.e. babies born before 37 weeks as their immune systems will be less developed.
• The risk will be higher if you have previously had a baby affected by Group B Strep.
• The risk will increase if you suffer a high temperature during labour or show signs of infection during labour.
• The risk will be higher if you have a positive urine or swab test for Group B Strep during pregnancy.
• If your waters break more than 24 hours before your baby is born there will be a greater risk.
If you are a carrier of Group B Strep late in pregnancy, it does not mean that your baby will develop group B Strep infection, but it does mean that your baby will have a higher chance of developing the infection than if you were not a carrier.
How is Group B Strep prevented?
Women identified with Group B Strep infection are treated with antibiotics (penicillin) during labour. However, if you are allergic to penicillin then a suitable alternative antibiotic will be offered.
If you are known to carry Group B Strep there is no need for antibiotics to be given to you before labour starts as this will not reduce the chance of your baby developing Group B Strep. Antibiotics will only be recommended at the point that your labour starts.
By giving the mother antibiotics during labour, it reduces the risk of her baby developing early onset Group B Strep from around 1 in 400 to 1 in 4000.
Following birth your baby may be kept in hospital for at least 12 hours to be monitored. This will allow medical staff to check the general wellbeing of your baby, as well as check their heart rate, temperature, breathing and feeding. If there is any concern that your baby has Group B Strep infection they will be treated with antibiotics until blood tests confirm whether Group B Strep is present.
With correct medical treatment 87-88% of babies diagnosed with early onset Group B Strep will make a full recovery.
Unfortunately, at the present time there are no known methods to prevent late onset Group B strep which develops usually between 7 days and 3 months of birth. Therefore, it is vitally important that you take note of the symptoms listed below and seek urgent medical attention when necessary.
Also, as Group B strep can be carried on the skin as a precaution before anyone handles a baby under 3 months they should ensure that they thoroughly wash their hands.
Symptoms of Early Onset Group B Strep (within 7 days of birth) include:
• High or low temperature
• Feeding problems- vomiting milk
• Breathing problems- struggling to get a breath or grunting when breathing
• Fast or slow breathing rate
• Fast or slow heart rate
• Irritability or fussiness
• Unresponsive or limpness (floppy)
• Changes in skin colour/ blotchy skin
Symptoms of Late Onset Group B Strep (normally within 3 months of birth):
• Irritable with high pitched whimpering, crying or moaning
• Blank staring or trance like expression
• Floppy or a dislike of being handled
• Tense or bulging fontanelle (soft spot on babies head)
• Dislike of bright light
• Involuntary stiff body or jerking movements.
When to seek urgent attention
If your baby is displaying the above symptoms, then you need to seek urgent medical attention as they may require antibiotics in hospital.
Always let healthcare professionals know if you previously had a baby who had Group B Strep or if you tested positive for Group B Strep during pregnancy.
If you have suffered Group B Strep in a previous pregnancy and your baby was unaffected then there is 50% chance you will be carrying it again. You may be offered a swab test (enriched culture medium ECM) to see if you are carrying Group B Strep when you are between 35-37 weeks pregnant and this will determine whether you should be offered antibiotics during labour.
What to do next
If you have any concerns about Group B Strep it is important that you talk to your midwife or GP as with proper medical treatment most early onset Group B Step infections are preventable.
Your may also wish to contact Group B Strep Support: www.gbss.org.uk