All women who have given birth in the US in the last several years know about the unpleasant Group B Strep (GBS) screen. It is usually performed around 35-37 weeks of pregnancy to test for the GBS strain of bacteria. A long cotton swab is rubbed around the vagina and anus, then the swab is sent off to the lab and determined to either be positive (GBS is present) or negative (GBS is absent). GBS is a normal component of the bodyâs microbiome and is found in the GI tract and genital region of around 25-30% of individuals without causing any symptoms. Babies can come into contact with GBS during vaginal birth, and if they end up with an infection in the first few days of life, such as pneumonia or meningitis, GBS is often the culprit. If a motherâs vagina contains GBS, her baby has 50% chance of picking up the bacteria during birth, and of those 50% of babies, 1% will develop a dangerous infection. Thatâs a small number, but a scary condition that no one wants their newborn to experience. Luckily with timely medical treatment the GBS-liked infections are treatable and most babies make a full recovery.
In the United States, and many other countries worldwide, mothers who are found to be GBS positive from the screening done in pregnancy are given high dose broad spectrum IV antibiotics during labor to prevent neonatal GBS infections. The IV antibiotics will be started as soon as the laboring woman enters the hospital, and the dose will be repeated every four hours until the baby is born. These prophylactic antibiotics are an effective way to prevent GBS transfer from mother to baby, but widespread use of antibiotics during labor could have negative consequences that are not being considered, including overuse of antibiotics that contributes to the evolution of antibiotic-resistant bacteria strains.
The use of IV antibiotics in labor can also effect how the birth proceeds. Women who are GBS positive are instructed to come to the hospital much earlier than GBS negative women, because it is recommended to get at least two doses of the antibiotics before delivery, and if these are spaced 4 hours apart, that means the woman will need to be at the hospital at least 8 hours before delivery. When a woman is admitted into the hospital early in labor she is put on the hospitalâs clock and more likely to be subjected to labor interventions such as pitocin augmentation, electronic fetal monitoring, and epidural anesthesia, all which can increase the risk of a surgical delivery. The use of IV antibiotics also increases the medicalization of childbirth by limiting mobility.Â
The UK is one exception to the GBS screening rule. In that country, they do not believe that there is enough evidence to prove that the benefits from the widespread use of prophylactic antibiotics outweighs the risks. A representative from the UKâs National Screening Committee made this statement recently, after the question of GBS screening was considered once again:
At the moment there is no test that can distinguish between women whose babies would be affected by GBS at birth and those who would not.
This means that screening for GBS in pregnancy would lead to thousands of women receiving antibiotics in labour when there is no benefit for them or their babies and the harms this may cause are unknown.
This approach also cuts against the grain of ongoing efforts to reduce the number of people receiving unnecessary antibiotics.
Much better evidence is needed on such widespread antibiotic use among pregnant women and whether it is possible to find a more accurate test.
Sadly, the review of the UKâs stance on GBS screening came about because of a baby who died from a GBS-linked infection. However, the number of those sort of deaths are so low that the NHS does not believe that they make antibiotics in labor necessary for upwards of 25% of all women. You can read more about the UKâs decision here, and The Royal College of Obstetricians and Gynaecologists statement on GBS prevention here.
The UKâs medical organizations are in favor of using IV antibiotics during labor for women who are GBS positive in order to reduce the transfer of GBS to the baby. The difference between the UKâs position and the USâs position is that the UK believes women should not be universally screened for GBS, but rather should only be screened if there is a medical indication such as a UTI or a skin infection. So the only women who would receive IV antibiotics in labor are those who have symptomatic GBS. The majority of women who have GBS do not experience any symptoms, so only screening symptomatic women and only giving those who are both symptomatic and GBS positive IV antibiotics reduces the use of antibiotics.
The UK is not alone in their stance. Other developed countries with excellent maternity healthcare and very low neonatal mortality rates do not screen for GBS, like Finland, Sweden, Israel, Austria, Iceland, and the Netherlands,
The question remains, by using the wide net of screening ALL pregnant women (versus only symptomatic women) and giving ALL of those whose screens come back positive prophylactic broad spectrum antibiotics in order to prevent a small number of possible infections in newborns, are countries like the US doing more harm than good? Â
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