Subscribe to RSS
Is Group B Streptococcus Colonization Associated with Maternal Peripartum Infection in an Era of Routine Prophylaxis?Funding This study was supported by the Intramural Research Program of the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The Consortium on Safe Labor was funded by the Intramural Research Program of the NICHD, through Contract No. HHSN267200603425C. Intramural investigators designed the study and data were collected by clinical site investigators. The corresponding author has full access to the data and final responsibility for preparation and submission of the paper for publication.
Objective This study aimed to assess whether colonization with group B streptococcus (GBS) is associated with maternal peripartum infection in an era of routine prophylaxis.
Study Design This study presented a secondary analysis of women delivering ≥37 weeks who underwent a trial of labor from the U.S. Consortium on Safe Labor (CSL) study. The exposure was maternal GBS colonization and the outcome was a diagnosis of chorioamnionitis, and secondarily, analyses were restricted to deliveries not admitted in labor and measures of postpartum infection (postpartum fever, endometritis, and surgical site infection). Logistic regression with generalized estimating equations was used accounting for within-woman correlations. Models adjusted for maternal age, parity, race, prepregnancy body mass index, pregestational diabetes, insurance status, study site/region, year of delivery, number of vaginal exams from admission to delivery, and time (in hours) from admission to delivery.
Results Among 170,804 assessed women, 33,877 (19.8%) were colonized with GBS and 5,172 (3.0%) were diagnosed with chorioamnionitis. While the frequency of GBS colonization did not vary by chorioamnionitis status (3.0% in both groups), in multivariable analyses, GBS colonization was associated with slightly lower odds of chorioamnionitis (adjusted odds ratio [AOR]: 0.89; 95% confidence interval [CI]: 0.83–0.96). In secondary analyses, this association held regardless of spontaneous labor on admission; and the odds of postpartum infectious outcomes were not higher with GBS colonization.
Conclusion In contrast to historical data, GBS colonization was associated with lower odds of chorioamnionitis in an era of routine GBS screening and prophylaxis.
Data in an era prior to routine group B streptococcus (GBS) screening and prophylaxis showed that maternal GBS colonization was associated with a higher frequency of maternal peripartum infection.
In the current study, GBS colonization was associated with lower odds of chorioamnionitis in an era of routine GBS screening and prophylaxis.
The results highlight potential benefits of GBS screening and intrapartum antibiotic prophylaxis beyond neonatal disease prevention, including mitigating the risk of maternal infectious morbidity.
This manuscript was presented as a poster presentation at the Infectious Diseases for Obstetrics and Gynecology (IDSOG) Annual Meeting, Big Sky, MT, on August 2019.
Received: 11 February 2020
Accepted: 08 March 2020
23 May 2020 (online)
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Russell NJ, Seale AC, O'Driscoll M. et al; GBS Maternal Colonization Investigator Group. Maternal colonization with group B streptococcus and serotype distribution worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65 (Suppl. 02) S100-S111
- 2 American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG committee opinion no. 485: prevention of early-onset group B streptococcal disease in newborns. Obstet Gynecol 2011; 117 (04) 1019-1027
- 3 Verani JR, McGee L, Schrag SJ. ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (Suppl. 10) 1-36
- 4 Minkoff HL, Sierra MF, Pringle GF, Schwarz RH. Vaginal colonization with Group B beta-hemolytic streptococcus as a risk factor for post-cesarean section febrile morbidity. Am J Obstet Gynecol 1982; 142 (08) 992-995
- 5 Krohn MA, Hillier SL, Baker CJ. Maternal peripartum complications associated with vaginal group B streptococci colonization. J Infect Dis 1999; 179 (06) 1410-1415
- 6 Yancey MK, Duff P, Clark P, Kurtzer T, Frentzen BH, Kubilis P. Peripartum infection associated with vaginal group B streptococcal colonization. Obstet Gynecol 1994; 84 (05) 816-819
- 7 Muller AE, Oostvogel PM, Steegers EA, Dörr PJ. Morbidity related to maternal group B streptococcal infections. Acta Obstet Gynecol Scand 2006; 85 (09) 1027-1037
- 8 Edwards JM, Watson N, Focht C. et al. Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study. Infect Dis Obstet Gynecol 2019; 2019: 5430493
- 9 Major UK clinical trial for Group B Strep screening in pregnant women announced 2019. Accessed July, 2019 at: http://www.nottingham.ac.uk/news/pressreleases/2019/may/major-uk-clinical-trial-for-group-b-strep-screening-in-pregnant-women-announced.aspx
- 10 Gopal Rao G, Hiles S, Bassett P, Lamagni T. Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross-sectional study. BJOG 2019; 126 (11) 1347-1353
- 11 Donders GG, Halperin SA, Devlieger R. et al. Maternal immunization with an investigational trivalent group B streptococcal vaccine: a randomized controlled trial. Obstet Gynecol 2016; 127 (02) 213-221
- 12 Wenckus DJ, Gao W, Kominiarek MA, Wilkins I. The effects of labor and delivery on maternal and neonatal outcomes in term twins: a retrospective cohort study. BJOG 2014; 121 (09) 1137-1144
- 13 Venkatesh KK, Glover AV, Vladutiu CJ, Stamilio DM. Association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery: a cohort study. BJOG 2019; 126 (06) 719-727
- 14 Tita AT, Szychowski JM, Boggess K. et al; C/SOAP Trial Consortium. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med 2016; 375 (13) 1231-1241
- 15 Hutcheon JA, Moskosky S, Ananth CV. et al. Good practices for the design, analysis, and interpretation of observational studies on birth spacing and perinatal health outcomes. Paediatr Perinat Epidemiol 2019; 33 (01) O15-O24
- 16 Turrentine M. Intrapartum antibiotic prophylaxis for Group B Streptococcus: has the time come to wait more than 4 hours?. Am J Obstet Gynecol 2014; 211 (01) 15-17
- 17 Desravines N, Venkatesh KK, Hopkins A. et al. Intrapartum group B streptococcus antibiotic prophylaxis in penicillin allergic pregnant women. AJP Rep 2019; 9 (03) e238-e243
- 18 Sutton JA, Rogers LM, Dixon BREA. et al. Protein kinase D mediates inflammatory responses of human placental macrophages to group B streptococcus. Am J Reprod Immunol 2019; 81 (03) e13075
- 19 Upadhyay K, Park JE, Yoon TW. et al. Group B streptococci induce proinflammatory responses via a protein kinase D1-dependent pathway. J Immunol 2017; 198 (11) 4448-4457
- 20 Rouse DJ, Landon M, Leveno KJ. et al; National Institute of Child Health And Human Development, Maternal-Fetal Medicine Units Network. The Maternal-Fetal Medicine Units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes. Am J Obstet Gynecol 2004; 191 (01) 211-216
- 21 Venkatesh K, Jackson W, Hughes BL, Laughon MM, Thorp JM, Stamilio DM. Association of chorioamnionitis and its duration with neonatal morbidity and mortality. J Perinatol 2019; 39 (05) 673-682
- 22 Ahmadzia HK, Heine RP. Diagnosis and management of group B streptococcus in pregnancy. Obstet Gynecol Clin North Am 2014; 41 (04) 629-647
- 23 Schrag SJ, Verani JR. Intrapartum antibiotic prophylaxis for the prevention of perinatal group B streptococcal disease: experience in the United States and implications for a potential group B streptococcal vaccine. Vaccine 2013; 31 (Suppl. 04) D20-D26
- 24 Van Dyke MK, Phares CR, Lynfield R. et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 2009; 360 (25) 2626-2636
- 25 Greenberg MB, Anderson BL, Schulkin J, Norton ME, Aziz N. A first look at chorioamnionitis management practice variation among US obstetricians. Infect Dis Obstet Gynecol 2012; 2012: 628362
- 26 Johnson CT, Farzin A, Burd I. Current management and long-term outcomes following chorioamnionitis. Obstet Gynecol Clin North Am 2014; 41 (04) 649-669