Group B Strep: Here's What You Need to Know
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Pregnancy can be both an exciting and stressful time for mothers. There’s a lot of information to digest regarding how to best care for your baby preterm and in the weeks that follow birth. During both periods, it’s important for expecting mothers to fully understand Group B Strep and how it could impact your pregnancy and birth.
Without the proper understanding and precautions, this common bacteria can cause life-threatening complications for newborn babies. Our team has compiled the following guide which details everything that expecting mothers should know about Group B Strep.
*Please note: The Cincinnati Birth Center cannot be held accountable regarding the use of the following information. If you’re unsure if something is right for you and your baby, please consult your doctor.
What is Group B Strep and how is it transmitted?
Group B streptococcus (otherwise known as Group B Strep or GBS) is a gram-positive bacterium that is naturally found in the lower intestine and vagina of 10-30% of all healthy adult women. A woman whose body carries GBS but who doesn’t show signs or symptoms of infection is said to be “colonized” with Group B Strep.
GBS is not sexually transmitted or contagious. Normally, GBS doesn’t cause any health problems. However, in some cases GBS may invade the body and cause serious infection called Group B Strep Disease. Babies can contract this disease from their mothers if it is present in her vagina and rectum at the time of birth. It’s also possible for GBS to be transmitted through intact membranes (before a woman’s water breaks) to the baby.
What are the risks of GBS?
In pregnant women, GBS can cause infection in the urinary tract or uterus, which are usually treated with antibiotics or alternative therapies. However, for babies GBS can pose a greater health risk. Some babies may become sick when exposed to GBS, typically within 7 days after birth. The risk of GBS is low but very serious, as it can cause pneumonia, meningitis, respiratory infections, or a blood infection which can all lead to death.
GBS is the leading cause of life-threatening infection in newborns. Preterm babies are more likely to die from GBS than full-term babies. When babies become infected with late-onset GBS disease (7 days or more after birth), it often develops into meningitis. Babies who survive any type of GBS may become blind, deaf, or have learning disabilities.
What are the risk factors of early-onset GBS disease?
Early-onset GBS is classified as babies who become sick within 7 days of birth. The risk factors of early-onset GBS disease are highest when:
A baby is born prematurely (before 37 weeks of gestation)
A mother develops a fever during labor
The mother’s bag of waters are ruptured for more than 18 hours before the birth
The mother had a previous baby with GBS disease
The mother is colonized with GBS in her pregnancy
**Last modified: October 26, 2021
How common is GBS disease?
Current statistics estimate that 0.34 - 0.37 infants/1,000 live births develop GBS infection. GBS causes approximately 1,200 cases of early-onset disease per year and nearly 70% of those babies were full-term. The mortality rate is 2-3% for term babies that contract GBS. In the absence of intervention, the CDC estimates that approximately 1-2% of babies born to GBS-positive mothers will develop an early-onset infection.
What are the symptoms of GBS disease?
The following symptoms could indicate GBS disease in the newborn and should be evaluated by a medical professional immediately:
● A fever of 100 degrees Fahrenheit or more
● Unstable temperature, either low or high (above 99 degrees or below 97 degrees)
● Difficulty breathing (grunting, flaring of the nostrils, retraction of the ribs)
● Not eating well
● Extreme drowsiness
● Irritability
● A heart rate that is either too low or too high (more than 160 beats per minute or less than 120 beats per minute)
How can mothers know if they’re colonized with GBS?
GBS can be detected by using a sterile swab to take a sample of fluids from the entrance of the vagina and from the area around the anus. Mothers can take the sample themselves, where it will then be taken to a lab and cultured to detect the amount of GBS present. Results are usually available within 72 hours.
In hospitals, this test is routinely performed at 35-37 weeks gestation. In out-of-hospital practices, testing is offered with informed choice. Since GBS is a transient infection, the results of the swab/culture are only considered accurate for about 2 weeks. The levels of GBS colonization can make a difference, as heavy colonization is associated with the most frequent and most serious neonatal illness. At times, when there is excessive colonization, GBS can be detected in a urine culture (although it is not always possible to detect GBS in the urine).
What are the benefits of being tested?
Being tested for GBS can help you best take appropriate action to protect you and your baby from sickness. The following are key benefits to being tested for GBS:
● If you test positive for GBS and choose to receive the course of antibiotics recommended by the CDC, the chance that your baby will develop early-onset GBS disease is very low
● If you test positive for GBS it may be an indication for you to strengthen your immune system and flora health
● If you test negative and need to transfer to the hospital, you will not be put on the routine IV antibiotics they use for women in labor whose GBS status remains unknown (although you may receive them for other indications)
● If you test negative for GBS or test positive and choose to receive antibiotics, it is less likely that your baby will be tested for GBS or be required to have antibiotics for GBS if they are transferred to the hospital for any reason
What are the risks of being tested?
There are no risks to taking the test itself and the test is fairly accurate. Local hospitals only accept GBS labs as accurate if they are done within about 2 weeks of birth, so we usually do testing at 37 or 38 weeks of gestation.
What are the risks of antibiotic treatment?
If you choose to undergo antibiotic treatment for GBS, there are a handful of risks you should be aware of:
● Currently, there is a 10% risk of developing a mild reaction such as a rash.
● There’s a 1 in 10,000 chance of developing a severe allergic reaction to penicillin. Anaphylaxis shock requires emergency treatment and can be life-threatening.
● Routine use of antibiotics for GBS-positive women may produce antibiotic-resistant organisms, making subsequent infections more difficult to treat.
● Antibiotics may produce unpleasant side effects such as diarrhea or yeast infections such as thrush, which can disturb the breastfeeding relationship.
● Use of antibiotics may allow other bacteria in the mother and baby to become resistant (especially E. Coli) and cause other complications, which in the rare worst case can be life-threatening.
● Use of antibiotics for GBS may have simply allowed other organisms to cause disease.
● Use of antibiotics weakens the immune system of the newborn causing significant long-term damage (Odent, M. 2012).
Are there alternative treatments available for GBS?
There are alternative treatments available; however, none of these treatments have been tested with scientific rigor. The healthier you and your intestinal tract are, the lower your chances are for colonization. General recommendations include obtaining enough sleep, eating a whole-food nutrient-dense diet that includes probiotic foods and low levels of processed foods. Eating vitamin C rich foods with bioflavonoids may help to strengthen your amniotic sac and reduce the chance of GBS transmission.
Here are a handful of alternative treatment methods available (which have NOT been tested with scientific rigor):
● Chlorhexidine washes during labor
There is medical evidence to suggest vaginal washing with chlorhexidine during labor is as effective as ampicillin in preventing vertical transmission of GBS. However, chlorhexidine has not been shown to reduce GBS disease in babies. A Cochrane review of the studies on chlorhexidine washes during labor led to the conclusion that there is not enough evidence to support using chlorhexidine on GBS-positive women during labor (Stade, B., Shah, V., Ohlsson, A. 2008).
● Prenatal oral therapies (these should be done until your baby is born)
These include high potency probiotics (20 billion or more) and multiple strains (8 or more) taken with each meal. Echinacea tincture by mouth 2-4x per day for no more than 2 weeks. Astragulus root tincture by mouth 2x per day. Vitamin C with bioflavonoids found in foods such as citrus peels, citrus, cabbage, cherries, rose hips, berries, and dark leafy greens. Garlic supplements are taken with each meal. Bee propolis (avoid if allergic to bees), several drops 2x per day.
● Vaginal therapies
These may include garlic sewn with a thread and inserted into the vagina at night for 12 hours. Garlic has been shown to kill GBS (Slohme-Cohaine, J., 2007). Additionally, “yoghurt sex” that is, using yogurt as a lubricant during intercourse to encourage a healthy vaginal flora. Rephresh, an over-the-counter pH balancer that will encourage the pH of your vagina to be normal, which will discourage infection. You may insert a yogurt-covered natural tampon into your vagina for 2 hours each day and/or insert a probiotic capsule into your vagina and leave it there every day.
Is there a law requiring treatment?
Currently, there is no law requiring treatment of GBS. The state of Ohio recommends routine testing at 35-37 weeks gestation and antibiotic treatment as per CDC guidelines.
Antibiotic treatment during labor is also recommended if the mother:
● Has a urinary tract infection
● Delivered a previous baby with GBS disease
● Develops a fever during labor
● Has not delivered her baby within 18 hours of her water breaking
● Goes into labor before 37 weeks and has not been tested for GBS
Antibiotics usually are not needed if the mother has a C-section delivery.”
What are other important factors to consider regarding GBS?
There are additional factors that are important to consider in regards to GBS. For one, if you carry GBS it is important that you maintain the health of your immune system. 80% of your immune system is in your gut bacteria. Avoid refined sugars and flour and eat fermented foods such as kefir, yogurt, and homemade sauerkraut or take a probiotic supplement.
Also, it’s important to note that GBS germs can travel or be transported into the womb by vaginal exams, even in early pregnancy, and if the exams are done with sterile gloves. GBS organisms can take hold of the genital tract and even cross the mucous plug and penetrate the membranes and infect the baby or damage the placenta, which could result in miscarriage or stillbirth. In later pregnancy, GBS may be introduced by routine cervical checks and other invasive procedures such as stripping the membranes, intrauterine fetal monitoring, and the application of cervical ripening medications. Unless there is a medical indication, we do not do routine internal examinations. Some indications for internal examinations are to assess the dilation of the cervix during pre-labor or at the onset of labor and birth care, to strip the membranes after 41 weeks, to determine fetal position, to provide information for a prolonged first or second stage of labor, and to rule out cord prolapse.
References and Resources:
CDC (2010) GBS Recommendations and reports. Retrieved from:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w Prevention of Perinatal Group B Streptococcal Disease
Cheng, P., Chueh, H., Liu, C., Hsu, J., Hsieh, T., Soong, Y. (2008) Risk Factors for Recurrence of Group B Streptococcus Colonization in a Subsequent Pregnancy. Obstetrics and Gynecology. Retrieved from:
http://journals.lww.com/greenjournal/Fulltext/2008/03000/Risk_Factors_for_Recurrenc_of_Gro up_B.17.aspx
Falcao, R. Group B Strep. Retrieved from: http://www.gentlebirth.org/archives/gbsAlt.html Fraser, D., Cooper, M. (2009) Myles textbook for midwives, 15th ed. London, UK: Elselvier. Odent, M. (2012) Childbirth from a bacteriological perspective. Midwifery Today, Issue 102, summer.
Ohio Department of Health. Retrieved from:
https://odh.ohio.gov/wps/wcm/connect/gov/7844bfac-dba5-4518-a287-0ecf8954b99b/s ection-3-strep-b-newborn.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTW ORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-7844bfac-dba5-4518-a287-0ecf8 954b99b-mymaxb.
Ohlsson A, Shah V. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD007467. DOI: 10.1002/14651858.CD007467.pub3
Slohm-Cohaine, J. (2007). How to treat a vaginal infection with a clove of garlic. MidwiferyToday. Issue 38, summer. Retrieved from:
http://www.midwiferytoday.com/articles/garlic.asp
Stade, B. , Shah, V., Ohlsson, A. (2008). Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection.
DOI: 10.1002/14651858.CD003520.pub2 Retrieved from:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003520.pub2/references 6
