Carol and Todd Johnson (names have been changed) were panicked when their daughter started having breathing problems a couple hours after birth. Everything had seemed fine, but soon her lungs and other body systems began to fail. “We had no idea what was going on. Doctors didn’t think she would make it,” recalls Todd. “We later found out that
Group B strep
caused this!”
Group B streptococcus (GBS), though rare, can cause serious illness or death in a newborn. GBS affects about one in 2,000 babies born in the United States each year. You might not have heard of this disease. But if you are pregnant or are thinking of getting pregnant, find out how a simple screening test and antibiotic treatment can protect you and your baby.
Group B streptococcus is a bacterium that normally lives in the gastrointestinal and genitourinary tracts and is commonly found on the body in vaginal and/or rectal areas. GBS can sometimes cause illness in newborn babies, pregnant women, elderly adults, and adults with chronic medical conditions, such as diabetes, liver disease, or cancer. This infection is generally easy to treat in adults, but for newborn babies, it can lead to life-threatening infections, such as sepsis (blood infection) and meningitis (infection of the fluid and lining surrounding the brain). In very rare instances, babies who have had meningitis can develop long-term problems, such as hearing and/or vision loss or learning disabilities, and can even die if the infection is left untreated.
Newborn babies become infected with GBS in three ways:
- Before birth: bacteria in the vagina can spread up the birth canal into the uterus and infect the amniotic fluid surrounding the baby. The baby becomes infected by inhaling the infected fluid into the lungs.
- During birth: the baby can come in contact with the bacteria in the birth canal.
- After birth: the baby can come in contact with the bacteria through intimate physical contact with the mother. (However, only 50% of late onset cases are linked to contact with the mother.)
Fortunately, not all babies who are exposed to the bacteria will become infected.
GBS is present in 10% to 35% of all healthy adult women. Not all women with the bacteria will pass it on. Having any of the following will increase the risk of passing the GBS bacteria on to the baby:
- A previous baby with GBS disease
- GBS bacteria present during the current pregnancy
-
A
urinary tract infection
(UTI) due to GBS
- Labor or rupture of the membranes (water breaking) before 37 weeks gestation
- A rupture of the membranes 18 hours or more before delivery
- A fever during labor
Usually, the pregnant woman has no symptoms of GBS. In pregnant women, GBS infections can cause infection of the uterine lining or amniotic fluid and lead to septic abortion. Two forms of infection occur in newborns.
Early-onset GBS
disease produces illness within six days of birth, usually within the first 24 hours. Symptoms include
sepsis,
pneumonia, and
meningitis. Between 5%-20% will die.
Late-onset GBS
usually occurs one week to three months after birth. Medical problems associated with late-onset disease may include sepsis and meningitis. There is a 15%-30% chance that infants with meningitis will have long-term problems, such as
cerebral palsy, hearing loss, and developmental problems.
Symptoms for both early and late onset include:
- Trouble breathing
- Irritability
- Temperature instability (high and low)
- Poor feeding
- Lethargy
About one in four newborns with late-onset GBS diseases can die with no treatment.
If you notice any of these symptoms in your baby (especially if you have tested positive for Group B Strep bacteria), notify a physician immediately.
Screening for GBS bacteria is simple. Your doctor will take a swab of the outside of the vagina and rectum about one month before the baby is due and will send this sample to a laboratory to test for the presence of the bacteria. Test results are usually available in 24–48 hours.
“Ironically enough," points out Todd Johnson, "my wife later recalled reading a magazine in the OB/GYN’s office regarding Group B strep and the American College of Obstetrics and Gynecology’s call for all obstetricians to begin routine testing of all their patients. She was never tested.” Carol and Todd’s experience with GBS highlights the importance of being tested for this very treatable disease.
If you test positive, current recommendations from the Centers for Disease Control and Prevention and other experts are that you receive antibiotics through an IV during your labor and delivery. It is generally not recommended that women take antibiotics before labor to prevent GBS (unless GBS is identified in the urine) because studies have shown that it is not protective at those earlier stages. The decision to take antibiotics is something you should discuss with your physician in order to assess the risks and benefits, but only intravenous antibiotics during labor have been shown to reduce a baby’s risk of becoming ill.
Fortunately, just because a baby is exposed to GBS, doesn’t mean he or she will get sick. However, if antibiotics are not given during labor, an exposed baby has at least a 1 in 200 chance of becoming seriously ill. Antibiotics reduce this risk twenty-fold, though they do not eliminate it completely. A baby diagnosed with GBS will be treated with intravenous antibiotics for about 10 days. Even with testing and antibiotic treatment, though, some babies could still get the disease despite screening. Many of their mothers appear to have risk for GBS even if their screening is negative. If you have any of the risks listed near the beginning of this article, it may be important to talk with your doctor about receiving treatment during labor – even if your screening test was negative. Vaccines to prevent GBS are currently being developed and should eventually allow us to eliminate this serious risk to newborns.
The first thing you can do is ask your OB/GYN to screen you for GBS before your delivery date at 35-37 weeks. If you have been identified as a GBS carrier, make sure to tell your doctor or midwife of your status when your water breaks or you arrive at the hospital in labor. By getting screened and treated during labor (if you have GBS), you can reduce the risk of your child developing GBS. Thankfully for Todd and Carol, their daughter suffered no long-term disability, but they feel that earlier screening and treatment would have prevented their emotional scars.
