Pregnant women who go into labour prematurely should be offered intravenous antibiotics to prevent transmission of Group B Streptococcal (GBS) to their baby, according to updated guidance by the Royal College of Obstetricians and Gynaecologists (RCOG).
The risks associated with GBS bacteria increase for babies born prematurely - the mortality rate from infection increases from 2-3% for babies born at term, to 20-30% for those born before 37 weeks.
For this reason, the RCOG guidelines now recommends all women who go into preterm labour receive intravenous antibiotics.
“We hope to reduce the number of early onset Group B Strep infections and neonatal deaths in babies born before 37 weeks,” said Professor Peter Brocklehurst, professor of women’s health at the University of Birmingham who co-authored of the guideline.
“Ensuring a consistent approach to care in all maternity units is vital to achieving the best outcomes for both mother and baby.”
The guidance also calls for all pregnant women to be provided with a leaflet containing “appropriate” information about GBS to support decision making and raise awareness of signs of the infection in babies, so it can be spotted early.
GBS is a bacteria that occurs naturally in the lower vaginal tract and is carried by about 150,000 pregnant women each year in the UK.
Most will suffer no ill effects, but in some cases they will pass the bacteria on to their baby during labour.
Women who go into preterm labour are at higher risk of passing GBS onto their baby - approximately one in 500 preterm babies will develop early onset GBS (which occurs in the first seven days of a baby’s life).
Incidence of early onset GBS appears to be rising in the UK, according to the RCOG, but with prompt treatment, 17 out of 20 diagnosed babies will fully recover.
However, two in 20 babies with GBS infection will recover with some level of disability, and one in 20 infected babies will die.
Aside from preterm birth, other risk factors for early onset GBS include having a previous baby affected by GBS, or prolonged rupture of membranes and a temperature of more than 38 degrees during labour.
The updated guidance also advises that women who were known carriers of GBS in a previous pregnancy can be offered a test at 35-37 weeks of pregnancy to see whether they are still a carrier, in order to reassess whether they still require antibiotics during labour.
In January 2016 a couple appealed for screening for GBS to be made available to all pregnant women, after their baby died from an infection that could have been prevented if caught early.
However, the revised guideline do not recommend universal screening for GBS, in line with recommendations made by the National Screening Committee (NSC).
It found that there is no clear evidence to show that routine testing would do more good than harm.
Speaking in February Dr Anne Mackie, director of programmes for the UK NSC, said: “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.”
The charity Group B Strep Support has welcomed the update to RCOG’s clinical guidance.
The charity’s chief executive Jane Plumb said it “represents a significant improvement in the procedure to prevent Group B Strep infection in newborn babies”.
“When fully implemented across the UK, we believe this change will make a real difference and we will see the rate of infections start to fall,” she said.
“We are delighted that the guideline recommends all pregnant women are provided with an information leaflet on GBS.
“Group B Strep Support has been working closely with the RCOG to develop this leaflet, which will significantly improve the quality and regularity of information on GBS.
“We are confident that this increased access to clear, concise information will play a vital role in raising awareness of GBS and empowering women to make informed decisions throughout their pregnancy and in the early days after birth.”
Signs And Symptoms Of Early-Onset Neonatal Infection
Parents and carers should seek urgent medical advice if they are concerned that their baby:
- is showing abnormal behaviour (for example, is inconsolably crying or listlessness)
- is unusually ﬂoppy
- has developed difﬁculties with feeding or with tolerating feeds
- has an abnormal temperature unexplained by environmental factors (lower than 36°C or higher than 38°C)
- has rapid breathing
- has a change in skin colour.