What Is Group B Strep?

Group B strep (GBS) is a bacteria naturally found in the digestive tract and birth canal of 1 in 4 pregnant women. These women “carry” or are “colonized” with GBS. However, GBS can come and go at any time so each pregnancy can be different. Babies can be infected by GBS before birth and up to 6 months of age because of their underdeveloped immune systems.

GBS most commonly causes infection in the blood (sepsis), the fluid and lining of the brain (meningitis), and lungs (pneumonia). It can cause babies to be miscarried, stillborn, or die after being born. Some GBS survivors have permanent handicaps such as blindness, deafness, mental retardation, and cerebral palsy.

HOW DO I KNOW IF I CARRY GBS?

You may carry GBS with or without symptoms, such as vaginal burning/irritation or unusual discharge. If you have symptoms, see your doctor promptly for a bacterial culture test.

GBS can also cause bladder infections, with or without symptoms. Ask your doctor to do a urine culture for GBS and other bacteria (not the standard prenatal urine check.) GBS in your urine means that you are heavily colonized, which puts your baby at greater risk.¹ Oral antibiotics should be prescribed.

It is now the standard of care in the USA and Canada for all pregnant women to be tested for GBS at 35 to 37 weeks of pregnancy. Your doctor will perform a swab test of your vagina and rectum and obtain the test results in 2-3 days. If the test result is positive, you carry GBS. Ask to make sure you are tested during each pregnancy!

Many hospitals now offer rapid, DNA-based tests such as the Xpert™ GBS  Assay (Cepheid, CA, USA). This test can be performed during labor or any time during pregnancy with results in less than 1 hour.² Rapid test results are important because your GBS status can change by the time you go into labor, culture tests can show a false negative, or your culture test results may not be available.

HOW CAN GBS INFECT MY BABY?

GBS can infect your baby before birth — even before your water breaks. Procedures such as cervical exams and stripping membranes or using cervical ripening gel to induce labor can all push GBS closer to your baby.^3-8

GBS can cause preterm labor so that your baby is born too early.

GBS can also cause your water to break prematurely without labor starting, causing your baby to lose a significant layer of protection.

Babies are most often infected with GBS as they pass through the birth canal. Internal fetal monitors can cause GBS to enter your baby’s bloodstream through the cut in his/her scalp.1 GBS infections within the first week of life are called “early-onset”.

Babies can become infected with GBS by sources other than the mother. GBS infections after the first week of life are called “late-onset”.

Be aware that your womb and/or C-section wound can become infected by GBS.

HOW CAN I BEST PROTECT MY BABY

...during pregnancy?

Ask your doctor to do a urine culture for GBS and other bacteria in at least your first and third trimesters.⁹

See your doctor promptly for any symptoms of vaginal infection.¹⁰

Make sure you are tested at 35-37 weeks.

Avoid unnecessary, frequent, or forceful internal exams. Internal exams can tell how far you are dilated, but do not accurately predict when your baby will be born.⁵ (Vaginal ultrasounds may be available as a less invasive alternative.³)

Talk with your doctor about not stripping your membranes or using cervical ripening gel to induce labor. ^4,6-8

Tell your doctor if you are allergic to penicillin. There are antibiotic alternatives.¹

Plan ahead if you have short labors or live far from the hospital. The intravenous (IV) antibiotics you should receive in labor generally take 4 hours to be effective. ¹

If you are having a planned C-section, ask to start IV antibiotics 4 hours before your incision. Your baby is still at risk if you have a C-section.

Talk to your doctor about whether or not to use internal fetal monitors during labor before you have had IV antibiotics for at least 4 hours. Benefits may outweigh the risks.

...when my water breaks or I start labor?

Call your doctor.

If you tested positive for GBS, immediately go to the hospital to start IV antibiotics.

If you do not have a GBS test result, and your hospital does not offer a rapid DNA-based test such as the Xpert™ GBS test, you should be offered IV antibiotics based on the following risk factors:

You have already had a baby with GBS disease.

You have had GBS in your urine during this pregnancy.

Your baby will be born before 37 weeks.

Your water has been broken 18+ hours without delivering. (Even 12+ hours increases the risk.¹¹)

You have a fever of 100.4 °F or higher during labor

In half of GBS infections, the mother has no risk factors.¹² This is why testing is so important!

...after my baby is born?

Antibiotics generally take 4 hours to be effective. If you give birth before this, the hospital may culture and observe your baby for 48 hours.

You can ask for your baby to have antibiotics while waiting for the results of the culture.

Some hospitals will give your baby a penicillin shot within 1 hour of birth to further reduce the risk of GBS infection.^1,14 Ask your doctor.

Have everyone wash their hands thoroughly before handling your baby.

Breastfeeding can supply your baby with important antibodies to fight infection. ¹⁵

WHAT GBS SYMPTOMS DO BABIES SHOW?

Take your baby to the emergency room or call your baby’s doctor immediately if you notice these signs:

High-pitched cry, shrill moaning, whimpering

Marked irritability, inconsolable crying

Grunting as if constipated

Projectile vomiting

Feeds poorly or refuses to eat

Sleeping too much, not waking for feedings

High or low temperature; hands and feet may still feel cold even with a fever

Blotchy, red, or tender skin

Blue, gray, or pale skin due to lack of oxygen

Fast, slow, or difficult breathing

Body stiffening, uncontrollable jerking

Listless, floppy, or not moving an arm or leg

Tense or bulgy spot on top of head

Blank stare

^ TOP

REFERENCES

1.   Morbidity and Mortality Weekly Report, Prevention of Perinatal Group B Streptococcal Disease Revised Guideline from CDC, Centers for Disease Control and Prevention, Vol. 51, No. RR-11. August 16, 2002.

 2.  Haberland et al., “Perinatal Screening for Group B Streptococci: Cost-Benefit Analysis of Rapid Polymerase Chain Reaction.” Pediatrics 110:3. September 2002.

3.  McGregor, James A., MD, CM, “Group B Strep: A Patient/Provider Approach for Optimizing Care.” www.OBGYN.net.

4.  The Jesse Cause, “Interview of Parents of GBS-infected Babies,” July 1997-Sept. 2002.

5.  Akin, W., Fatheree, D., Klausing, C., “Vaginal Exams in Late Pregnancy.” www.childbirth.org.

6.  Akin, W., Fatheree, D., Klausing, C., “Stripping the Membranes.” www.childbirth.org.

7.  DeMott, K., “Cervical Manipulations linked to Perinatal Sepsis: Consider GBS-specific Chemoprophylaxis.” (Eight Case Reports),” OB/GYN News, Oct. 15, 2001.

8.  Hannah, Mary E. MD,CM, et. al. “Maternal colonization with Group B Streptococcus and prelabor rupture of membranes at term: The role of induction in labor.” Am J Obstet Gynecol 177:780-785. 1997.

9.  Antimicrobial therapy for obstetric patients. ACOG educational bulletin no. 245. Washington, D.C.: American College of Obstetricians and Gynecologists, 245:8-10, March 1998.

10. McGregor, James A., MD, “Infection and prematurity: the evidence is in,” Medical Tribune Opinion, Feb. 6, 1997.

11. Rosenstein N., Schuchat A. Neonatal GBS Disease Study Group. Opportunities for prevention of perinatal group B streptococcal disease: A multistate surveillance analysis.” Obstet Gynecol 90:901-6. 1997.

12. Society of Obstetricians and Gynecologists of Canada, Canadian Pediatric Society. National Consensus statement on the prevention of early-onset group B streptococcal infections in the newborn. J Soc Obstet Gynaecol Can 1997 Publication number 61. June 1997.

13. CDC/NCID “Group B Streptococcal Infections” Brochure, August 1998. 

14. Siegel, Jane D. MD, Cushion, Nancy B., MBA, RN. “Prevention of Early-Onset Group B Streptococcal Disease: Another Look at Single-Dose Penicillin at Birth”. Obstet Gynecol 87:692-8. 1996. 

15.  Lagergard T, Thiringer K, Wassen L, Schneerson R, Trollfors B. Department of Medical Microbiology, University of Goteborg, Sweden. “Isotype composition of antibodies to streptococcus group B type III polysaccharide and to tetanus toxoid in maternal, cord blood sera and in breast milk.” Eur J Pediatr. 151(2):98-102. Feb 1992.