Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data

Mark A. Turrentine; Laura C. Colicchia; Emmet Hirsch; Po-Jen Cheng; Teresa Tam; Patrick S. Ramsey; Sarah M. Page-Ramsey

doi:10.1055/s-0035-1569988

American Journal of Perinatology, Table of Contents

Am J Perinatol 2016; 33(05): 510-517
DOI: 10.1055/s-0035-1569988

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data

Authors

Mark A. Turrentine

¹Department of Obstetrics and Gynecology, Kelsey-Seybold Clinic, Houston, Texas
Laura C. Colicchia

²Division of Maternal Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Emmet Hirsch

³Department of Obstetrics and Gynecology, NorthShore University HealthSystem and University of Chicago, Evansten and Chicago, Illinois
Po-Jen Cheng

⁴Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Taoyuan, Taiwan
Teresa Tam

⁵Department of Obstetrics and Gynecology, Presence Saint Francis Hospital, Chicago, Illinois
Patrick S. Ramsey

⁶Division of Maternal Fetal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas

⁷Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Sarah M. Page-Ramsey

⁸Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Abstract

Objective The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk.

Study Design A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel–Haenszel fixed effect model.

Results In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84–7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02–2.31).

Conclusion Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m², race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.

Keywords

group B streptococcus - pregnancy - recurrence

Full Text

References

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