Theoretical Approaches to the Prevention of Peripartum GBS Neonatal Sepsis in Pregnancy and Delivery at Term

7/22/2019

James M. Nicholson, MD MSCE

James M. Nicholson, MD MSCE
Dr. Nicholson graduated from the University of Pennsylvania School of Medicine in 1984 and completed his residency in Family Medicine with the Duke-Watts Program in North Carolina in 1987. He was in private practice in Northeastern Connecticut until 1997, at which time he returned to the University of Pennsylvania to teach maternity care/obstetrics within that institution’s newly formed Family Medicine Residency Program At the University of Pennsylvania, he developed a research agenda that focused on the regular use of risk-based labor induction to lower cesarean delivery rates and published several major research papers. In 2012 Dr. Nicholson moved to the Penn State Hershey Family Medicine Residency Program and while there he spearheaded a study that identified an association in the USA between decreasing early term labor induction activity and increasing term stillbirth rates. This past December, Dr. Nicholson joined the Wellspan Medical Group in Central Pennsylvania. He continues to pursue research focusing on the impact of variable rates of labor induction on term pregnancy outcomes.

Marti Perhach

7/23/2019 07:57:18 am

Thank you, Dr. Nicholson, for the very thought-provoking presentation! I hope many studies are generated from your talk.

Jim Nicholson

7/23/2019 08:19:35 am

Happy to be a part of the conference!
Very willing to field any/all questions and/or talk about research ideas. Best e-mail is: [email protected].

Group B Strep International

7/23/2019 12:13:22 pm

Which entities do you think would be most likely to conduct studies for some of the mentioned proposed research areas? We have often thought how helpful it would be to have studies done on the efficacy of alternative treatments and are not aware of any being done besides oral probiotics to reduce GBS colonization.

James Nicholson

7/24/2019 10:56:16 am

Not sure what entities are doing this research. Marti @ GBSInternational might know. Ideally such research would measure eradication - as well as relative reduction - and would also consider type of GBS (different types might respond differently) as well as important initial risk factors (race, parity, prior history of GBS sepsis, maternal BMI, etc).

Akeno

7/23/2019 11:15:10 am

Great research ideas. I, myself, am interested to see more research regarding how probiotics impact GBS colonization rates.

7/24/2019 11:01:06 am

In the attempt at prevention, at least two approaches could be considered: several combined interventions that together obtain the desired outcome, and then determine which ones (or combination[s]) are most effective, or trying one at a time (or specific combination[s] at a time). Either way is ok, but I personally would approach this by using multiple holistic approaches to see if eradication (or reduction) of GBS colonization is possible without the use of antibiotics, and then determining what holistic intervention is most effective.

Mary Li

7/23/2019 01:04:51 pm

I really appreciate your talk. I wonder how future research on GBS risk factors like race will contribute to prevention efforts

7/24/2019 11:07:24 am

Race could certainly be a factor, but race has recently been described as a risk factor that is difficult to really get a handle on. Race is linked with multiple other risk factors, and many other risk factors are probably important in a propopsed preventive paradigm for any type of GBS sepsis. I may not have emphasized the point well enough in the presentation, but I tend to believe that many "diis-eases" have multiple important risk factors - so probably more than race would need to be considered - at least initially - in the development of an efficient preventive approach.

7/23/2019 01:54:28 pm

Do you think vaginal pH testing could be useful for detecting heavy GBS colonization for possible intervention or identification of risk?

7/24/2019 11:14:47 am

Well worth consideration, and would be relatively easy to study. Vaginal pH could be tested at the same time as GBS assay/culture to see if a correlation exists - and if so how strong the correlation is (measuring false +'s and false -'s). Again, it might be important to determine the type of GBS along with its presence, and the degree/intensity of colonization. This is an example of the consideration of a possible risk factor - but then the finding of an "abnormal" vaginal pH (higher than normal, I assume) would only mean a higher likelihood of heavy GBS colonization and would not per se lead to prevention. An effective intervention would be needed to complete a successful prevention strategy. Maybe certain strategies would be better in the setting of abnormal pH 9with GBS positivity) and others would be better in the setting of normal pH (with GBS positivity). So lots of questions....

Kate Braye

7/25/2019 05:31:50 pm

ear Dr Nicolson
Thank you for your presentation, I havent seen GBS presented like this before, and I thought your 4 paridgms of prevention were a great way to start a talk about this issue. I note you didnt mention antibiotic resistance and the role clinicians play in this field and also the dybiosis IAP creates in the newborn, leading to potentially serious adverse health outcomes. I feel parents need to be informed about thses two issues when making a decision about screening and subsequent prophylaxis for GBS

7/26/2019 05:33:48 am

Thanks for the comment and excellent questions. There are clearly many areas that could be researched regarding the many aspects of GBS sepsis - including best methods for prophylaxis.

The issue of IAP is an example of the tension between individual patient/provider choice for treatment and societal issues related to widespread policies. On an individual basis, IAP is probable the best protection NOW regarding GBS sepsis, but over time its routine use may lead to the development of antibiotic resistant strains of GBS and we do not know as much as we should about biome issues. I am sure that if a baby develops GBS sepsis after IAP was withheld, then the mother/family will not be very happy.....and the concept of preventing dysbiosis and the concept of preventing antibiotic resistance would be very unimportant. On the other hand, society as a whole should be interested in preventing both over time.

As noted in earlier comments, additional preventive strategies should ideally be created - and that will require better understanding of GBS sepsis (and the different types of GBS sepsis), better understanding of the risk(s) for GBS sepsis (and which patients to focus on), and better (more effective and safer) interventions.

Ideas like natural methods to reduce GBS colonization and the intentional "seeding" of babies with beneficial bacteria after C/S birth or antibiotic prophylactic altered birth might be effective/safer interventions........but both MIGHT cause unexpected harm.....and that is what research would need to determine.

Absent high-quality research, we can talk a lot with parents prior to birth, but the conversation will be based on opinion rather than scientific guidance. Who better suited to start research these issues that people who attended this conference (and you!!!).

Again, thanks for the questions.

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