As many as 8000 babies in the United States could be born with serious Group B Strep disease, and possibly 10% of those babies will die. Of the babies who do survive Group B Strep menigitis, approximately 20% of them will have permanent handicaps such as hearing or vision losses or learning disabilities.
What is Group B Strep? Group B Strep (GBS) is a bacterium found in the lower intestine of healthy adults and also in the vagina of approximately 10-33% of all healthy adult women. According to the Centers for Disease Control, many individuals carry Group B Strep in the bowel, vagina, bladder or throat and do not become ill. They are simply carriers or said to be "colonized." GBS should not be confused with the strep that causes strep throat, as that is Group A Strep. GBS colonization is not contagious. It is important to note that GBS is NOT a sexually transmitted disease.
Since 1 in 5 pregnant women carry GBS in the rectum or vagina, those babies who come in contact with GBS during birth may begin showing signs of complications such as sepsis (blood infection), pneumonia or meningitis (infection of the fluid/lining around the brain) during the first few hours after birth. Premature babies are more at risk due to their premature body systems. The babies may be exposed during the journey through the birth canal, where they may swallow or inhale the bacteria. Having a cesarean section is not likely to prevent GBS. Babies who present symptoms soon after birth may have problems regulating their own body temperature, fever, seizures, breathing problems, stiffness, or extreme limpness.
Babies who have late onset GBS/meningitis may show signs of stiffness, limpness, inconsolable screaming, fever and lack of interest in feeding. Babies with a positive blood or spinal fluid culture are typically treated with IV antibiotics. GBS cannot be contracted through breastfeeding and women who are colonized may breastfeed without concern.
Some research indicates that GBS may cross the intact amniotic membranes, thus exposing the baby in utero. There, it may cause preterm births, stillbirths or miscarriage.
The Group B Strep Association stresses policy that has GBS testing for every woman. Testing can be done around 35-37 weeks of pregnancy. A swab sample from the vagina and rectum can show culture results in approximately 2-3 days and is relatively inexpensive (usually under $50). This test, known as the LIM or selective broth medium test is considered the best test, although sometimes it can be inaccurate. A positive culture means that the woman is colonized but the test does not show if she has the disease and cannot predict if the baby she is carrying will get the disease.
Maternal risk factors for developing GBS disease:
- Positive culture for GBS colonization at 35-37 weeks.
- Having already had a baby who had a GBS infection.
- GBS bacteria in urine.
- Membranes rupture more than 18 hours before birth.
- Premature labor (less than 37 wks)
- Developing high fever in labor (greater than 100.4F)
- African American race
- Less than 20 years old.
Source: Group B Strep Association
If a mother has been identified as being positive or colonized, she should receive IV antibiotics approximately 4-6 hours before the birth of the baby, or sooner such as at the time of hospital admission. Since all medications, including antibiotics, do have side effects, the Group B Strep Association suggests limiting their use to those women with one or more risk factors listed in the above table.
Not all care providers routinely test for GBS - some base their testing on evaluation of risk factors alone. The Group B Strep Association states "Babies are healthy in at least 95% of births where the mother is properly tested and treated for GBS colonization." The Centers for Disease Control and American College of Obstetricians and Gynecologists concur with the Group B Strep Association that testing at 35-37 weeks and IV antibiotic therapy offers the best protection in comparison to evaluation of risk factors alone.