Group B Streptococcus

What is group B streptococcus?

Group B streptococcus (GBS) is a bacterium that can be found in the digestive tract, urinary tract, and genital area of adults. Although GBS infection usually does not cause problems in healthy women before pregnancy, it can cause serious illness for the mother and baby during pregnancy and after delivery.

Why is group B streptococcus a concern?

One out of every four or five pregnant women carries GBS in her rectum or vagina. In the pregnant mother, GBS infection may cause chorioamnionitis (a severe infection of the placental tissues) and postpartum (after birth) infection. Urinary tract infections caused by GBS can lead to preterm labor and birth.

Newborns can contract GBS during pregnancy, or from the mother's genital tract during labor and delivery. GBS is the most common cause of life-threatening infections in newborns, including pneumonia and meningitis. About one out of every 100 to 200 babies whose mothers carry GBS develop symptoms of GBS disease. Nearly 75 percent of the cases of GBS disease among newborns occur in the first week of life, called early-onset disease. Premature babies are more susceptible to GBS infection than full-term babies.

Although it is very rare, GBS infection may also develop in babies one week to several months after birth, called late-onset disease. Meningitis is more common with late-onset GBS disease. Only about half of late-onset GBS disease among newborns comes from a mother who is a GBS carrier. The source of infection for others with late-onset GBS disease is unknown.

How is group B streptococcus diagnosed?

GBS can be cultured from the mother's vagina or rectum with a swab during a pelvic examination. GBS can also be cultured from a mother's urine. Cultures are usually done between 35 and 37 weeks of pregnancy and may take a few days to complete. Cultures collected earlier in pregnancy do not accurately predict whether a mother will have GBS at delivery.

In infants, GBS may be cultured from samples of sterile body fluids, such as blood or spinal fluid. Most newborns with GBS infection have symptoms in the first few hours after birth. Symptoms are related to the body systems that are affected by the infection and may include breathing problems, changes in blood pressure, or neurologic problems such as seizures.

Treatment for group B streptococcus:

Treatment of GBS depends on when GBS infection is diagnosed - during pregnancy or after delivery. Specific treatment for GBS will be determined by your physician based on:

• the pregnancy and birth history, overall health, and medical history
• extent of the disease
• your baby's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

If the mother has a positive GBS culture during pregnancy, the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend treatment with intravenous (IV) antibiotics during labor to reduce the risk of transmission of the infection to the baby. Treatment may also be needed for women with certain risk factors, including the following:

• fever during labor
• rupture of membranes (bag of waters) for 18 hours or longer
• labor or rupture of membranes before 37 weeks gestation
• history of GBS infection in a previous baby

Newborns who become ill with GBS infection may require care in the newborn intensive care unit (NICU). They are usually treated with intravenous (IV) antibiotics. Other treatments and specialized care may be needed depending on the severity of the infection and whether the infection causes serious problems such as meningitis or pneumonia.

Prevention of group B streptococcus:

It is important to understand that, in spite of testing and treatment, some babies still develop GBS disease. Research is ongoing to develop vaccines to prevent GBS disease. In the future, women who are vaccinated against GBS may make antibodies that cross the placenta and protect the baby during birth and early infancy.

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