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VBAC

"Awareness of Group B Streptococcus Infection During Pregnancy"

"Awareness of Group B Streptococcus Infection During Pregnancy: Help Protect Your Baby and Yourself"

pamphlet issued by: The Group B Strep Association

WHAT IS GROUP B STREPTOCOCCUS INFECTION?

Since the early 1970's, the bacteria Group B Streptococcus (GBS) has been identified as the number one cause of life threatening infections in newborn babies.

This bacteria is normally found in the vagina and/or lower intestine of 15% to 40% of all healthy, adult women. Those women who test positive for GBS are said to be colonized.

Group B Streptococcus should not be confused with Group A Streptococcus which causes strep throat.

The vast majority of GBS infections are acquired during childbirth when the baby comes into direct contact with the bacteria carried by the mother.

An estimated 12,000 infants in the United States will become infected with GBS each year. This bacteria will result in the death of an estimated 2,000 infants yearly, while leaving many others mentally and/or physically handicapped.

GBS usually causes infant illness within the first seven days of life, but late onset infections may occur up to three months of age. Performance of a cesarean section will not eliminate the risk of infection.

GBS infections are more common than other illnesses for which pregnant women are screened, such as rubella, Down's Syndrome and spina bifida. Yet, GBS remains generally unknown to the public.

Fortunately, there is testing and a preventative treatment available that can help prevent many of these infections.

ENCLOSED ARE SOME INFORMATIVE FACTS ABOUT:

  • GBS infections
  • the testing available to identify women who carry GBS;
  • an effective treatment that can help prevent many of these infections;
  • future hopes for a vaccine;
  • a nonprofit organization that can provide additional information to pregnant women, prospective parents, families and their friends.

GBS AND PREGNANCY

"Do All Women Carry GBS?"

If 1000 women, regardless of race or socioeconomic status, had a vaginal culture taken, 150-350 would test positive for GBS. Because GBS usually does not cause problems for the adult female, most women carry it and do not know it. Yet, GBS can cause serious illness in babies born to women who carry the bacteria.

"Is GBS a Sexually Transmitted Disease?"

Since GBS is normally found in the vagina and/or rectum of colonized women, one way it can colonize another individual is through sexual contact. However, this bacteria usually does not cause genital symptoms or discomfort and is generally not linked with increased sexual activity. Therefore GBS is not considered to be a sexually transmitted disease.

"How Common Are GBS Infections?"

Out of every 1000 births, three babies will become ill with GBS. Why only certain infants fall victim to this infection is not completely known. An estimated 12,000 babies will suffer from GBS infections each year.

"What Complications Does GBS Cause?"

Most often, GBS colonizes the baby during labor either by traveling upward from the mother's vagina into the uterus, or as the infant passes through the birth canal. Illness occurs when the bacteria enters the baby's blood stream. This can then lead to shock, pneumonia, and meningitis (an infection of the baby's spinal fluid and brain tissue). In certain cases, evidence exists that GBS may cross intact membranes to infect the baby in utero. All of these conditions are life threatening. This year alone:

  • an estimated 2000 babies will die;
  • large numbers will suffer permanent handicaps such as brain
damage ranging from mild learning disabilities to severe mental retardation, loss of sight and hearing, and lung damage (full statistics do not exist for the total number of surviving babies who will have these permanent handicaps);
others will survive with no long-term damage.

GBS is also responsible for causing infections in nearly 50,000 pregnant women each year including fever after birth, uterine inflammation, and infections following cesarean sections.

"When is GBS a Threat?"

GBS can be present in a woman's first pregnancy, or in following pregnancies. The bacteria can be a threat both during pregnancy and at the time of delivery. It has been shown that women who carry large amounts of the bacteria are at greatest risk of having a baby infected with GBS. Also, the occurrence of GBS infections are increased in certain high risk situations.

HIGH RISK SITUATIONS:

  • When labor is premature;
  • When there is premature rupture of the membranes;
  • When there is prolonged rupture of membranes (>12 hours) before the baby is born;
  • If the mother has a fever (>100.4 F) before or during labor;
  • Women who have a history of GBS in previous births.

"Can GBS Infections Be Prevented?"

Yes. There is a fast and effective treatment for many situations. Medical research indicates that giving antibiotics through the vein to the mother during labor can greatly reduce the frequency of GBS infection in the baby immediately after birth or during the first week of life.

Treating the mother with oral antibiotics during the pregnancy may decrease the amount of GBS for a short time, but it will not eliminate the bacteria completely and will leave the baby unprotected at birth. Also, waiting to treat the baby with antibiotics after birth is often too late to prevent illness.

"How Do I Know If I Carry GBS?"

Some doctors routinely screen for GBS by doing cultures on their patients during pregnancy. These cultures must be taken from the lower vagina and rectum, not the cervix.

Women who are found to carry the bacteria can then be treated as potential GBS risk patients. But, just like any other bacteria in the human body, GBS can be present in small amounts on one day which would result in a negative culture. Therefore, one negative culture result does not guarantee that you will be negative on the day you deliver. (Current studies indicate that a lower vaginal AND rectal culture done late in pregnancy is more than 93% accurate in detecting who will not carry the bacteria at delivery.)

"Can I Be Tested Again At The Time Of Delivery?"

A rapid test has been developed that can detect the presence of GBS from a vaginal swab. This test can be completed during labor and will identify women who carry large amounts of GBS.

Infants born to these heavily colonized women are at greatest risk of infection. Women who carry less amounts of the bacteria may not be identified by the test; however, medical research indicates that their babies are at lower risk of becoming infected. Although GBS can strike anyone, infants at greatest risk of infection are those that fall into the HIGH RISK SITUATIONS mentioned previously. It is in these situations that it could be particularly beneficial to perform the rapid test during labor to determine of the mother is carrying GBS.

"What If My Culture Of Rapid Test Is Positive?"

Because so many women carry GBS, and not all of their babies become ill, many physicians believe that antibiotics should not be given to all women who test positive for the bacteria. This would result in the unnecessary treatment of a large number of women. Instead, the focus is on the high risk patients. If a woman is found to carry GBS and falls into one or more of the high risk situations during labor, her doctor can immediately start antibiotic treatment which will help protect the baby and the mother.

"Future Hopes For A Vaccine"

Although the focus of GBS testing and treatment is on high risk infants and mothers, GBS also strikes infants and mothers who do not appear to have any risk factors at birth. As a result, researchers are actively working on the development of a GBS vaccine which would protect infants and mothers in the future. Use of the vaccine in adult women would create an immunity, which during pregnancy could cross the placenta and protect the baby. Although widespread use of a vaccine is still years away, this is the solution that will protect future babies regardless of risk factors.

THE CHOICE IS YOURS

No one really knows ahead of time if she will find herself in a high risk situation during pregnancy or labor. Now that you are aware of GBS disease, please take the time to discuss GBS testing and preventative treatment with your doctor.

The American Academy of Pediatrics recommends that all pregnant women be screened for GBS bacteria between 35 and 37 weeks of pregnancy, (women who test positive should be offered antibiotic treatment during labor) and that all women who have risk factors PRIOR to being screened for GBS (for example, women who have preterm labor beginning prior to 37 completed weeks' gestation) are treated with IV antibiotics until their GBS status is established.

The Centers for Disease Control state that it is cost effective to routinely screen pregnant women for GBS. They further state that is all women are screened at 35-37 weeks gestation and all GBS+ moms are treated with IV antibiotics in labor, more than 3/4 of all cases of GBS in the first week of life could be prevented.

GROUP B STREP ASSOCIATION
Dedicated to the fight against GBS infection.

Group B Strep Association is a nonprofit organization formed by parents whose babies were victims of GBS infections. Having experienced the pain and devastation of this illness, these parents sought the help of prominent researchers and physicians from all over the country. These doctors responded with great support and have joined together to act as the Medical Advisory Board for the organization. Together we hope to create public awareness of GBS disease, to bring about guidelines for testing and treatment of GBS, and to generate continuing support for vaccine research. Our greatest underlying purpose is to serve the public by being a resource for both information and support.

The Group B Strep Association was formed:
In memory of all the babies who have died;
In sympathy for all the babies left handicapped;
For the sake of all the babies yet to come.

The Group B Strep Association does not represent or endorse any particular manufacturer's product related to testing or treatment of Group B Strep infection.


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