Group B Strep

What is Group B Streptococcus?

Group B Streptococcus has many names: Group B Strep, GBS, Strep B. It is part of the normal bacteria found in the intestinal and/or reproductive tracts of about 20% of healthy people in Vancouver. Under normal circumstances it is part of the balanced system of gut flora that does not cause disease. It is not associated with bad hygiene, nor is it sexually transmitted. GBS may come and go in people’s bodies, so having had it previously does not mean you have it now.

How can GBS affect my baby?

If you have GBS in your vagina when you give birth, your baby obviously will be exposed to it. Most of the time this is of no consequence. In fact, of those babies who are exposed only 50% will become carriers of GBS – i.e. they will have GBS on their skin or in their system.

But about 1 in 200 babies who are exposed to GBS will develop a systemic infection. Symptoms can include fever, irritability, trouble breathing or lethargy. These babies will need hospitalization and IV antibiotics. Further, of those who do get sick, for 1 in 20 this infection will be fatal. Babies that survive, particularly those who have meningitis, may have long-term problems such as hearing or vision loss, or learning disabilities.

Most GBS infection will be obvious at birth or within the first 24 hours, but can develop anytime within the first week. (This is called early onset GBS infection. There is also a late onset GBS disease that begins after the first week, but this is caused by transmission after birth.)

In summary, out of 4000 babies exposed to GBS:

2000 will become carriers …….. 2000 will not become carriers

20 will become sick …………….. 3980 will not get sick

1 will die ……………………………. 3999 will survive

What might increase my baby’s risk of getting sick from GBS?

The following risk factors multiply by 10 the chance of your baby getting sick:

  • Previous baby that developed GBS infection
  • Bladder infection caused by GBS at any time during this pregnancy
  • Preterm birth <37 weeks
  • Maternal fever in labour >38OC
  • Ruptured membranes >18 hrs

What are my options for testing and treatment?

Currently, the community standard is to test women at 35-37 weeks (which is a cotton-swab or “Q-tip” sample from your vagina and anus that you can do yourself). This swab is sent to the lab to be cultured and usually takes a 2-3 days to get results.

The test is done at the end of pregnancy because GBS bacteria can be present in your body temporarily. Testing within 5 weeks of your due date has been shown to be the most accurate way to determine your status at the time of birth.

If your test comes back positive:
  • The most common approach is to offer you treatment with IV antibiotics once you are in active labour OR if your water breaks before labor. The drug of choice is Penicillin, but there are other effective options for women who are allergic to Penicillin, or for strains of GBS that are resistant to Penicillin.
  • Once started on antibiotics, you will receive a dose every four hours until you have your baby. Ideally, you will receive at least one dose a minimum of one hour before the birth, as this reduces the chance of your baby getting sick to 1 in 4000. Subsequent doses reduce the chance even further. Between doses, which take about 15 minutes to complete, a saline lock will be place on the IV so you aren’t constantly attached to an IV pole.
  • If your water breaks before labour starts, you will be offered the choice of inducing labour. The reason for this is to minimize the chance of infection due to prolonged ruptured membranes, which we know may increase the chance that you will pass on GBS to your baby.
If your test comes back negative:
  • You will not be offered antibiotics unless you develop signs of infection, which would likely be due to organisms other than GBS.
If your GBS status is unknown:
  • If you go into labor before test results are available, then you will be offered antibiotics only if you develop any of the risk factors listed above.

What are the downsides of antibiotic treatment?

Having an IV inserted can be uncomfortable or painful, and the plastic IV catheter in your arm can be somewhat annoying in labor.

Long term effects on baby of early antibiotic exposure are not fully researched.

Are there any alternatives to treatment with antibiotics?

There are no other treatment alternatives that have enough data for us to know whether they are effective.

Some parents may wish to avoid antibiotics, and will request an alternative approach to treatment with antibiotics where 1) they are found to be a GBS carrier, and 2) they develop any of the risk factors mentioned above which make it ten times more likely that the baby will get sick. This approach was based on a previous standard of care before universal testing and treatment for positive status was adopted.

Is it possible to still plan a homebirth or to labor at home as long as possible?

The short answer is yes! We can easily administer antibiotics at home once you are active labor.

In the general population, there is about a 1 in 10,000 chance of having a severe allergic reaction requiring emergency treatment to these antibiotics, which is considered extremely rare. If you have a strong history of antibiotic allergies (i.e. a higher chance of having an anaphylactic reaction), your midwife may discuss the option of doing at least the first dose in the hospital.

Can I prevent or eliminate GBS from my system?

The best strategy is to boost your own immune system by being as healthy as you can manage. Daily exercise and nutrient-dense food is always a good idea! Additionally:

THROUGHOUT YOUR PREGNANCY:
  • Take a daily probiotic supplement
  • Eat foods high in Vitamin C
  • Eat fermented foods – a natural source of probiotics
  • Minimize your refined carbs & sugars
  • Keep hydrated – drink lots of water
FOR TWO WEEKS BEFORE YOUR TEST:
  • Minimize heavy starches (potatoes, rice, bread, etc) or combine with proteins
  • Cut out all refined sugars as well as high-sugar fruit (e.g. tropicals such as bananas, mangos, papaya, etc)
  • [optional] Take a daily Vitamin C supplement of 500-1000mg
  • [optional] Take Echinacea tincture – 1 dropperful 1-3x/day
  • [optional] Do a nightly sitz bath with 1-2 drops of Tea Tree essential oil

 

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