Information For All Parents about Group Beta Strep Disease of the Newborn Ingrid Gold, LM, CPM, CNM Group Beta Strep Colonization in Women: Group Beta Strep (GBS) is a bacteria that can cause a serious infection in newborn babies. GBS is a usually benign organism that lives in many women’s vaginas. Just like most of us have staph bacteria on our skin and e. coli bacteria in our colon, GBS bacteria lives in many people’s bodies without ever causing a problem or being in any way noticeable to them. If a woman has GBS in her vagina, she is considered "colonized" with the bacteria. It lives in her vagina without causing her any problems. The complications arise when a woman colonized with GBS gives birth. The GBS can, under certain circumstances, cause a life threatening infection in the baby. 10 to 30% of women are colonized with GBS. Group Beta Strep Disease in the Newborn: 50% of babies born to colonized mothers will themselves be colonized with GBS. Most of them will never know they are colonized, because GBS usually is a benign bacteria. 2% of colonized babies will develop GBS disease. GBS disease of the newborn is a very serious infection. GBS disease usually develops in the first few hours after birth, although symptoms sometimes take a week to appear. GBS disease results in sepsis (an overwhelming infection), pneumonia (a lung infection), and meningitis (a brain infection). Premature babies are more fragile and more at risk for complications after birth. They are also more at risk for GBS infection and more likely to have a serious infection than full-term babies. Most babies who get GBS disease are born full-term (75%). Babies who are most at risk of GBS disease: those born prematurely (less than 37 weeks) those born after the membranes have been ruptured for more than 24 hours those who’s mother had a fever during labor. Women who’s previous baby(s) had GBS disease are also at high risk to have another baby with GBS disease. Babies who develop signs of GBS disease can be treated with antibiotics (usually Penicillin), but treatment does not always prevent damage or death from the disease. 6% of babies with GBS disease will die and 20% of those who survive will have some kind of permanent disability such as hearing and vision loss or brain damage. GBS disease occurs in 2 out of every 1000 newborn babies. Detecting Group Beta Strep Colonization in Pregnant Women: Because GBS disease is a rare but very serious disease, studies have been done to determine which women are colonized with GBS. It is possible to do a simple vaginal/rectal swab at 35-37 weeks of pregnancy to test for the presence of GBS in the mother. Unfortunately, because of the nature of the GBS bacteria, cultures are not always accurate in assessing colonization. It is possible for a colonized women to have a positive culture one day and a negative one the next. Some of this is due to difficulties with the culture itself, and some of it seems to relate to variations in the number of bacteria present at any specific time. Cultures done at 35-37 weeks of pregnancy will detect 85% of colonized mothers. Unfortunately, that means that 15% of women tested will believe they are not at risk, when they actually are colonized with GBS, but the test did not detect it. Therefore, it is possible for a baby to contract GBS disease without the mother testing positive for GBS. Remember also that testing positive for GBS colonization does not mean that your baby will get GBS disease. Only 2% of babies of colonized mothers will develop GBS disease. Preventing Group Beta Strep Disease: Because treatment of newborns with GBS disease after they are born is often not enough to prevent major complications, pediatricians and obstetricians have collaborated to study ways to prevent as many cases of GBS disease as possible. Possible treatment strategies that have been explored include simply treating all newborns or all newborns of colonized mothers with one dose of antibiotics (a shot of penicillin) shortly after birth. Because the disease usually develops in the first 12 - 24 hours of life, it was hoped that the disease could be prevented by pre-treating newborns at risk. Unfortunately, this treatment was not shown to prevent GBS disease. The idea of treating all pregnant women who are colonized with GBS during the pregnancy has also been explored. Women who tested positive by culture for GBS were treated and most of them were positive again three weeks later. There does not seem to be a way to eradicate this bacteria from women’s bodies. Treating women during pregnancy did not reduce the rate of GBS disease in their babies. Treating women during labor with IV antibiotics has been shown to prevent GBS disease in the newborn. The antibiotic must be given at least four hours prior to the birth to allow the antibiotic to pass into the amniotic fluid and treat the baby. If colonized women are given antibiotics during labor, 90% of newborn GBS disease is prevented. Antibiotic Treatment to Prevent Group Beta Strep Disease: If treating mothers during labor will prevent 90% of GBS disease, than why don’t we simply give all laboring women antibiotics? The answer should be fairly obvious to most of you: some people are allergic to Penicillin and will have a reaction to the treatment that could be worse that the disease, giving antibiotics to all (or most) pregnant women will lead to the growth of bacteria that are resistant to antibiotic treatment, and treatment is expensive and logistically difficult to give to all laboring women. 10% of women given Penicillin or Ampicillin will have a mild allergic reaction to the antibiotics (such as a rash). 1 in 10,000 will have a serious allergic reaction, called anaphylaxis, which is life-threatening. Prenatal Testing Strategy: If all pregnant women are tested for GBS and those who are positive are treated with antibiotics during labor, 27% of all laboring women in this country will get antibiotics. This will prevent 90% of GBS disease. Using this strategy, all women will be tested during pregnancy and those with positive cultures will be recommended to have IV antibiotic treatment during labor. Risk Factor Treatment Strategy: If only those women at high risk to deliver a baby with GBS disease are treated with antibiotics during labor, 18% of all laboring women in this country will get antibiotics. This will prevent 70% of GBS disease. Using this strategy, all women giving birth prematurely, all women who’s water is broken for more than 18 hours, and all women with fever during labor will be recommended to have IV antibiotic treatment. Also, anyone with a previous child with GBS disease and anyone with a GBS Urinary Tract Infection during pregnancy will be recommended to have antibiotic treatment during labor. How Do We Best Prevent GBS Disease of the Newborn? In 1996 a consensus conference was held by the Centers for Disease Control and Prevention (CDC) between the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) to determine the best way to prevent GBS disease. The pediatricians mostly favored treating most women during labor. They argued that this would prevent most cases of GBS disease. The obstetricians argued in favor of narrowing the criteria for who would be treated during labor so as to minimize the number of mothers and babies exposed to antibiotics. There were, of course, great concerns that any strategy be easy to implement and cost effective. Obstetricians were concerned about the logistics of having the culture results available whenever a woman went into labor, and what to do if a woman arrived in labor and testing either hadn’t been done or results were not available. The CDC published a paper in 1996 recommending that every obstetrical practice choose to follow either the Prenatal Testing Strategy or the Risk Factor Treatment Strategy. All midwives and obstetricians must inform their clients about the risks of GBS disease and which strategy they are using. The Childbirth Center Policy on GBS Prevention: So as to minimize the number of our clients who get antibiotics, but still prevent most GBS disease, the Childbirth Center has decided to follow the Risk Factor Treatment Strategy: · The following clients will be recommended to have IV Ampicillin during labor: Labor prior to 37 weeks Ruptured membranes for more than 18 hours Fever during labor Previous child with GBS disease or GBS UTI during pregnancy · Any client who would like to be tested for GBS colonization at 35-37 weeks may request the test from their midwife. If she is positive, she will be recommended to have IV Ampicillin during labor. IV treatment can be done at the Childbirth Center will not affect any other aspect of your care at CBC.