Submitted by: Itsme

This is the FAQ for Group B Streptococcus infection during pregnancy. It is taken from the Group B Strep Association pamphlet. Help protect your baby and yourself!

WHAT IS GROUP B STREP INFECTION?

Group B Streptococcus (GBS) is a type of bacteria that is found in the lower intestine of 10-35% of all healthy adults and in the vagina and/or lower intestine of 10-35% of all healthy, adult women. GBS should not be confused with Group A Strep, which causes strep throat. A person whose body carries GBS bacteria but who does not show signs of infections is said to be "colonized" with GBS. GBS colonization is not contagious. GBS bacteria are a normal part of the commonly found bacteria in the human body. Normally, the presence of GBS does not cause problems. In certain circumstances, however, GBS bacteria can invade the body and cause serious infection: this is referred to as GBS disease.


WHO MAY BE AFFECTED BY GROUP B STREP DISEASE?

• 15,000 to 18,000 newborns and adults in the U.S. will contract serious GBS disease each year, resulting in the bloodstream, respiratory and other devastating infections.
  
  
• About half of all GBS disease occurs in newborns and is acquired during childbirth when a baby comes into direct contact with the bacteria carried by the mother.
  
  
• GBS causes infection in pregnant women - in the womb, in the amniotic fluid, following caesarean sections, and in the urinary tract. Each year there are over 50,000 cases of such infections in pregnant women.
  
  
• 35-40% of GBS disease occurs in the elderly or in adults with chronic medical conditions.

GROUP B STREP AND YOUR BABY

• How Common is GBS Disease in Newborns?
  
  Approximately 8,000 babies in the U.S. contract serious GBS disease each year. Up to 800 of these babies may die from it and up to 20% of the babies who survive GBS-related meningitis are left permanently handicapped. In newborns, GBS is the most common cause of sepsis (infection of the blood) and meningitis (infection of the fluid and lining surrounding the brain) and is a frequent cause of newborn pneumonia. GBS disease is more common than other, better known, newborn problems such as rubella, congenital syphilis, and spina bifida. Some babies that survive, especially those who develop meningitis, may develop tong-term medical problems, including hearing or vision loss, varying degrees of physical and learning disabilities, and cerebral palsy.
  
  
• How Do Babies Get Sick From GBS Disease?
  
  Typically, babies are exposed to GBS during labor and delivery; they may also be exposed after the mother's membranes rupture ("water breaks"). Babies can come in contact with GBS if the bacteria travels upward from the mothers' vagina into the uterus; they may also be exposed to it while passing through the birth canal. The babies become infected when they swallow or inhale the bacteria. There is also evidence that GBS may cross intact membranes to expose the baby while it is still in the womb. There it may cause pre-term births, stillbirths or miscarriages. However, these may be caused by a variety of factors; other infections, stress, genetic defects for example- so be sure that any of these complications are investigated fully even if you are colonized with GBS.
  
  
• Are Certain Babies More Vulnerable to GBS Disease?
  
  Premature babies, with their less-developed bodies and immune systems, are more vulnerable to GBS infections than other older infants. Premature babies infected with GBS are at higher risk for long-term complications and/or death. Since most babies are born full term, however, full term babies account for 70% of the cases of GBS disease in newborns. The majority (80%) of the cases of GBS disease among newborns occur in the first week of life. This is called *early onset* disease. Most of these babies are ill within a few hours after birth. Babies who develop early onset disease may have one or more of the following symptoms: problems with temperature regulations, grunting sounds, fever, seizures, breathing problems, unusual change in behavior, stiffness, or extreme limpness. GBS disease may also develop in infants one week to several months after birth. This is called *late onset* disease. Meningitis is more common with late onset GBS disease. About half of late onset GBS disease can be linked to a mother who is colonized with GBS; the source of infections for other babies with late onset GBS disease in unknown. The baby who develops late onset GBS disease may exhibit the following signs: stiffness, limpness, inconsolable screaming, fever, or refusal to feed.
  
  
• How is a baby tested for GBS disease?
  
  Babies who develop the signs listed above should be evaluated immediately by a doctor. Blood tests, cultures, and x-rays can help determine if a baby has GBS disease, and treatment should begin immediately.

GBS BACTERIA AND DISEASE IN PREGNANT WOMEN

• How is GBS Transmitted? IS GBS a Sexually Transmitted Disease?
  
  GBS is naturally occurring bacterium in the human body of both women and men. Since it is commonly found in the vagina, some people wonder whether GBS is a sexually transmitted disease. The answer is "no". GBS bacteria usually do not cause genital symptoms of discomfort and are not linked with increased sexual activity. Women found to carry GBS do not need to change their sexual practices.
  
  
• Can Pregnant Women Be Checked for GBS Colonization?
  
  The GBS Association advocates that every pregnant woman be screened for GBS. One third, or 1,200,000 pregnant women carry GBS Bacteria. Knowing your culture result before you go into labor can help protect your baby's life.
  
  The test should be performed late in pregnancy, around 35 -37 weeks of gestation. The test involves collecting a swab or swabs from the lower vagina and rectum and culturing the sample on a special medium (LIM or selective broth medium). The test result is usually ready in 2 or 3 days and it usually costs between $15 and $35. This culture is considered the "Gold Standard"-- *It is the best screening available*. Unfortunately, it is not perfect and may miss a small number of women (approx. 5%) who carry GBS. Fortunately, it is accurate in detecting the bacteria as the "Gold Standard" culture but may be beneficial in a setting where a pregnant woman had not received prenatal care.
  
  A positive culture result means that the mother is colonized with GBS. It does *NOT* mean that she has GBS disease or that her baby will become ill. Rather, a positive test means that a woman and her doctor need to plan for her labor and delivery with this test result in mind. The results of GBS cultures should be available at delivery. If they are not available a woman should not hesitate to tell a doctor or nurse her results as soon as she arrives in the Labor and Delivery ward.
  
  If you are pregnant, ask your health care professional about testing for GBS. If the test is not offered, you should request it. Ask to be cultured for GBS during pregnancy, discuss treatment plans with your doctor, and tell your baby's doctor, pediatrician, or newborn nursery nurse about your culture result. By doing these things you can help prevent a GBS infection.
  
  
• What are a Mother's Risk Factors For Developing GBS Disease?
  
  
  • Positive culture for GBS colonization at 35-37 weeks
  • Having already had a baby who had a GBS infection
  • GBS bacteria in urine (bacteriuria, either with or with our symptoms)
  • Membrane rupture (having your "water break") more than 18 hours before delivery
  • Labor or membrane rupture before 37 weeks
  • Developing a fever during labor (higher than 100.4F)
  
  The baby's doctor and nurse should be told if the mother has any of the above risk factors.

PREVENTING GBS DISEASE

• How Can GBS Disease in Newborns and Mothers Be Prevented?
  
  Giving antibiotics (such as penicillin) through the vein during labor and delivery to women who have a positive GBS test or who have certain risk factors effectively prevents most GBS infections in women and their newborns. For best protection, the mother would receive intravenous antibiotics at least 4- 6 hours before delivery. However, the earlier the administration of antibiotics the better once a risk factor has been identified. For example , a woman who has had a previous GBS baby should have IV antibiotics started at the time of hospital admission, whether labor takes 14 hours or 6 hours.
  
  If a woman's labor begins or her membranes rupture before 37 weeks of pregnancy (before a culture is collected) she should be offered IV antibiotics.
  
  Since the antibiotics can cause side-effects, which are usually mild but can be severe, their use should be limited to those women who have one or more of the listed risk factors- the decisions to take antibiotics during labor should balance risks and benefits. If you are allergic to penicillin, consult your doctor to learn about other effective antibiotics. Caesarean sections are not likely to prevent GBS disease. Unfortunately, no prevention plan is 100% effective. Some women with GBS escape detection because they do not have risk factors.
  
  *All* women should be tested for GBS with **EACH** pregnancy to ensure that the very best available protection is provided for their babies.
  
  
• Is There a Vaccine for GBS?
  
  Researchers are actively working to develop a GBS vaccine. Use of the vaccine in adult women will stimulate the immune system to make protective proteins, called antibodies, which could cross the placenta later in pregnancy and protect the baby. Although widespread use of the vaccine is still years away, vaccination will one day protect babies and others from this bacterial infection.
  
  
• Should Women Who Have Had A Previous GBS Positive Baby Have More Children?
  
  Women who have had problems due to GBS in the past should inform their prenatal care provider and pediatrician. GBS infections can be prevented and managed in subsequent pregnancies so that babies are protected and born healthy and free of GBS.

GBS AND BREAST FEEDING

No data suggests that breast feeding can pass GBS from a mother to her baby; women colonized with GBS may breast feed without concern about harming their newborns. As always, keep hands and nipple area clean.

PREVENTION IS KEY!!

In at least 90% of the births where the mother is properly tested and treated for GBS colonization, the babies are healthy, so remember to:

• Ask your heath care professional to culture you for GBS between 35 -37 weeks
• Discuss antibiotic treatment plans with your doctor
• Tell your baby's doctor and nurse about your culture result before the baby is born.

Some doctors may not routinely offer testing for GBS but may base treatment decisions on obstetric risk factors alone. 25% of all GBS infected babies will be born to a mother who had no obstetric complications. This prevention plan will not prevent as many infections as routine screening combined with antibiotics for those mothers who culture positive for GBS.

ROUTINE PRENATAL CULTURE AT 35 -37 WEEKS OF PREGNANCY ALONG WITH IV ANTIBIOTICS DURING DELIVERY FOR THOSE MOTHERS WHO CULTURE POSITIVE FOR GBS OFFERS THE VERY BEST PROTECTION AVAILABLE FOR THE NEWBORN. According to the Centers for Disease Control and Prevention, this method potentially protects more babies than prevention by obstetric risk factors evaluation alone.


OTHER GBS RESOURCES

To subscribe to an e-mail mailing list for learning about GBS, e-mail your request to: gbstrep-request@kjsl.com with 'subscribe' in the subject line.

If you have trouble subscribing to the list, or for birth stories involving Group B Strep, contact cheryls@wco.com and Cheryl will help you.

A Note from the Organizers of the mailing list:
The goal of the mailing list is to inform ourselves about GBS, its effects and treatment, so that we may increase awareness of it among OB/GYN's, midwives, childbirth instructors and the general community while lending a listening ear to those who have lost babies to GBS or who have had children become sick from it. We are excited about giving each other support and helping each other educate other people so they don't have to go through what we did. On the list we have , pediatricians, midwifes, ob/gyn's, GBS specialists and nurses to help answer your questions. So far this has been a low volume list. Be thinking about your labor story as you will be asked to tell us if you wish.
Please pass the word on!

If you have questions after reading the FAQ, e-mail Lisa Porter

GROUP B STREP ASSOCIATION
Dedicated to the fight against GBS infection. It was formed In memory of all the babies who have died; in sympathy for all the babies left handicapped; for the sake of all the babies yet to come.

To contact the GBS Association, call (919) 932 5344
or write P.O. Box 16515
Chapel Hill, North Carolina 27516

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