Being pregnant is an exciting time, full of expectations of a happy and healthy baby. But for women who may become pregnant or are pregnant it’s important to know the risks and signs for Group B Streptococcus (GBS) and how it can affect your baby.
July is GBS awareness month and we want to do our part to help educate our customers about this potentially deadly infection.
GBS is a type of bacteria that is naturally found in the digestive and lower reproductive tracts of both men and women. About 1 in 4 pregnant women carry GBS.
Carrying GBS does not mean that you are unclean, nor is it considered a sexually transmitted disease or infection. However, like other infections, it can be passed between sexual partners, including through oral contact.
Most women do not have any symptoms of GBS, but it can cause vaginal burning/irritation and/or unusual discharge which may be mistaken for a yeast infection and treated incorrectly. If you have “vaginitis” symptoms, see your care provider promptly for an exam and possible GBS testing.
GBS can also cause bladder infections, with or without symptoms. Your doctor should do a urine culture for GBS and other bacteria at your first prenatal visit. GBS in your urine means that you may be heavily colonized which puts your baby at greater risk. If your urine tests positive, your provider should consider you as “GBS colonized” for this pregnancy so that you receive IV antibiotics for GBS when labor starts or your water breaks.
Call your doctor immediately if you have decreased or no fetal movement after your 20th week or if you have any unexplained fever.
It is now the standard of care in the US and several other countries for all pregnant women to be routinely tested for GBS at 35–37 weeks during each pregnancy unless their urine already cultured positive in the current pregnancy. (Since levels of GBS can change, each pregnancy can be different.) Your doctor will perform a swab test of both your vagina and rectum and receive the test results in 2–3 days. Inform your doctor if you are using antibiotics and/or vaginal medications which may cause false negative results. If you are unsure of what you are taking, bring your prescriptions and other medications with you to your appointment.
If you do test positive for GBS, be sure to keep a copy of all culture test results with you at all times. If you live far away from the hospital, or have a history or short labors, be prepared! The IV antibiotics you receive in labor take about 4 hours to be their most effective. Ask your doctor about a late third-trimester penicillin shot as a possible safeguard. Tell your doctor if you are allergic to penicillin.
Be aware of “alternative medicines”.
Garlic or tea tree oil and other alt medicines have not been proven to prevent babies from becoming infected with GBS. Some are unsafe for babies. One mother (as noted on a GBS website) followed an alternative regimen of acidophilus, echinacea, garlic capsules, vitamin C, grapefruit seed extract, and garlic suppositories to eradicate GBS from her body when pregnant. Her baby was 7 pounds, 20.5 inches and perfect at birth after a normal labor and delivery at home. He died 11 hours later from a group B strep infection in his lungs.
According to the CDC, in the United States, group B strep is the leading cause of meningitis and sepsis in newborns. GBS also causes more than 1,200 babies per year to become infected after the first week of life up to several months of age–sometimes from sources other than the mother.
No one knows how often babies are miscarried or stillborn due to GBS because many parents don’t choose to have autopsies or placental testing done for their deceased babies, and death certificates are rarely updated with the findings so prenatal-onset cases are mostly overlooked for statistical purposes.
Unfortunately, babies can be infected by GBS before birth and up to about 6 months of age due to their underdeveloped immune systems.
- GBS can infect your baby even before your water breaks. GBS infections before birth are called “prenatal-onset.”
- GBS can cause preterm labor, causing your baby to be born too early.
- GBS infection can also cause your water to break prematurely without labor starting, causing your baby to lose a significant layer of protection.
- It is thought that babies are most often infected with GBS as they pass through the birth canal. GBS infections within the first week of life are called “early-onset.”
- Babies can become infected with GBS by sources other than the mother. GBS infections after the first week of life are called “late-onset.”
- Be aware that your womb and/or C-section wound can become infected by GBS.
Early-onset neonatal sepsis usually occurs within the first 7 days of life, and is typically caused by infection with group B streptococcus. About 90% of cases present within 24 hours of birth. Of the babies with GBS:
- 69% present with sepsis
- 26% present with pneumonia
- 13% present with respiratory distress
- 11% present with meningitis
Risk factors for early-onset group B streptococcal infection:
- Maternal infection (group B strep-positive vaginal culture at delivery)
- Birth weight of 5.5 pounds or less
- Gestation 37 weeks or less
- Prolonged rupture of membranes during birth
- Intrapartum (during the birth process) fever greater than 99.5 degrees F
- Chorioamnionitis (inflammation of the fetal membranes due to a bacterial infection, usually occurring during a long labor.)
- Maternal ethnicity – Black and hispanic women
- Mothers who smoke
- Maternal age under 20 years old
- Frequent (more than 6) vaginal exams during labor and delivery
Late-onset group B streptococcus infection occurs from 7 to 9 days of age, through to the end of the second month of life. Late-onset infection typically presents with:
- 100% cases of fever
- 60% cases of meningitis
Call your pediatrician or take your baby to the emergency room immediately if he or she has any of these symptoms:
- High-pitched cry, shrill moaning, whimpering, inconsolable crying, constant grunting as if constipated.
- Fast, slow, or difficult breathing.
- Blue, gray, or pale skin, blotchy or red skin, tense or bulging fontanel (soft spot on a baby’s head), infection (pus/red skin) at base of umbilical cord or in puncture on head from internal fetal monitor.
- Feeding poorly, refusing to eat, not waking for feedings, sleeping too much, difficulty being aroused.
- Marked irritability, projectile vomiting, reacting as if skin is tender when touched, not moving an arm or leg, listless, floppy, blank stare, body stiffening, uncontrollable jerking.
- Fever or low or unstable temperature, hands and feet may feel cold even with a fever.
Sources: CDC, NIH, and GBS International.