UK Obstetricians Recommending Earlier Antibiotics for Group B Strep Infections in Pregnant Women

Doctors in the United Kingdom are recommending that antibiotics should be given to women who have preterm labor (before 37 weeks) to avoid the transmission of group B streptococcal (GBS) disease to their newborns. The new guideline is from the Royal College of Obstetricians and Gynaecologists.

According to the Centers for Disease Control and Prevention (CDC), GBS bacteria can cause illness in individuals of all ages, but the infection can be most severe in newborns. In addition to the most common symptoms of fever, difficulty feeding, irritability or lethargy (indicated as limpness or hard time trying to wake the baby), difficulty breathing, and a blue-ish color to skin, major complications such as sepsis and meningitis can occur.

Data from the United Kingdom and Ireland indicate that in 2015, about .57 of every 1000 live births are affected by the bacteria. In the United States, the 2015 rate was .23 for every 1000 live births.

Current US guidelines from the CDC indicate that, “pregnant women should undergo vaginal-rectal screening for GBS colonization at 35-37 weeks,” and should receive intrapartum antibiotic prophylaxis (IAP) if the following conditions are met:

• Delivering a previous infant with GBS disease
• GBS bacteriuria in the current pregnancy
• GBS-positive screening result in the current pregnancy
• Unknown GBS status with delivery at less than 37 weeks’ gestation, an intrapartum temperature of 100.4°F or greater, or rupture of membranes for 18 hours or longer.

The UK National Screening Committee, however, recommends, “against routine screening because of a lack of evidence of benefit and the potential for harm from increased antibiotic use,” according to an editorial on the new guidance published in the BMJ.

This may change as a result of a new review on which the Royal College of Obstetricians and Gynaecologists guideline is based.

For the review, researchers analyzed, “all published articles on GBS and pregnancy since 2011,” and found that, “the risk of women transmitting GBS disease was highest in those with preterm labor, as 22% of babies with the infection diagnosed in 2015 were born prematurely,” according to the editorial. Indeed, they found that the risk of developing GBS was only 1 in 2000 in babies born at term, compared with 1 in 500 for those babies born preterm. In addition, the rates of mortality were strikingly different, with full-term babies carrying a 2%-3% risk, and preterm babies carrying a 20%-30% risk.

As a result, the new guideline indicates that practitioners should offer intravenous antibiotics, “to all women who go into preterm labor, to prevent transmission of GBS infection.” In addition, the recommend that IAP should be offered to “all women who had a previous baby with early or late onset GBS disease.”

“This revised guideline will provide standardized treatment of pregnant women with GBS and reduce the risk of their babies developing the infection,” said Janice Rymer, vice president of education for the Royal College of Obstetricians and Gynaecologists in the editorial. “The guideline also aims to raise awareness of GBS by recommending that all pregnant women are provided with an appropriate information leaflet, which the [Royal College] is now updating.”

In the United States, a large disparity in incidence of GBS is seen across different races, with white individuals see a rate of .15 / 1000 live births, and black individuals seeing a rate of .57 / 1000 live births. The CDC’s Health People 2020 initiative is working towards a decrease across all races to .23 / 1000 live births.