With the wonderful news about the meningitis vaccine now being available on the NHS, people have also been talking about Group B Strep. During Group B Strep July Awareness Month, national charity Group B Strep Support wants more women to be informed about group B Strep and more health professionals to be equipped to tell pregnant women in their care about group B Strep. Group B Strep is life-threatening infection in newborn babies in the UK and of meningitis in babies up to the age of three months. We asked the experts to explain it in a little more detail.
Do you know about group B Strep?
Expecting a baby can be one of the best times of your life. So it is good to know about group B Strep during pregnancy because, although it can cause severe infections in newborn babies, most of these infections are preventable.
What is group B Strep infection?
Group B Strep is the most common cause of life-threatening infection in newborn babies in the UK and of meningitis in babies up to the age of three months. It is more common than spina bifida and as common as Down’s syndrome, yet pregnant women are not routinely told about it.
Although rarely dangerous to adults, a pregnant woman who is carrying group B Strep can pass it on to her baby around birth. At least 500 babies a year in the UK become infected. One in 10 of these sick babies die, one in 20 survivors suffers long-term problems, and five in 10 survivors of group B Strep meningitis suffer long-term mental and physical problems.
The good news is that with prompt and appropriate treatment, most babies will fully recover from their group B Strep infection – but prevention is better than cure.
How do I know if I am carrying group B Strep?
Most people don’t know if they carry group B Strep as there are no symptoms. Those who do know they carry it often find out from tests taken during pregnancy for other reasons.
Testing pregnant women for group B Strep as a routine part of a pregnant woman’s antenatal care is not currently recommended in the UK. Instead national guidance on prevention uses a maternal ‘risk-factor’ approach to predict which newborn babies are likely to develop group B Strep.
These risk factors include:
- Mum has had a previous baby who had group B Strep infection
- Group B Strep is found in Mum’s urine or on a vaginal or rectal swab this pregnancy
- Mum has a high temperature in labour (37.5 c or higher)
- Labour starts or waters break before 37 weeks of pregnancy
- Waters break more than 18 hours before the baby is born
Sadly, this approach seems to have had little if any effect on the rate of early-onset group B Strep infections in babies – the rate has not fallen since guidelines were introduced in 2003. Furthermore, up to 40% of babies who do become affected are born to mothers without any of these risk factors, other than unknown group B Strep carriage within the mother. Risk-factors are not accurate predictors of group B Strep infection.
Testing is the only way to identify whether a woman is carrying group B Strep. If group B Strep is found during the current pregnancy, then steps can be taken to minimise the risk of the infection in newborn babies – offering Mum, where group B Strep carriage has been detected in current pregnancy, intravenous antibiotics at the start of labour and at intervals until delivery.
“I want a test – where do I go, what do I ask for and when should I have it”?
Although the UK National Screening Committee (UK NSC) does not recommend routine antenatal testing for all pregnant women, you can ask your NHS Trust or you can order a private, home-testing pack (approximately £35).
The conventional NHS test – Standard Direct Plating Method – is available within most NHS Trusts and detects a wide range of bacteria that can cause infection. However, it is not sufficiently sensitive to detect group B Strep carriage reliably, providing up to 50% false negative results (although a positive result is very accurate).
The Enriched Culture Medium (ECM) test – is recognised at the ‘gold standard’ for detecting group B Strep carriage in pregnant women, and is very good at identifying when group B Strep carriage is present. When performed within five weeks of delivery, a negative result is 96% predictive of NOT carrying group B Strep at delivery and a positive result is 87% predictive of still carrying group B Strep at delivery.
The ECM test, however, is not widely available within NHS trusts – you can order your home-testing packs from a number of private laboratories. Visit GBSS.
Testing for group B Strep at 35-37 weeks of pregnancy is good at predicting the likelihood of your carrying group B Strep when you are most likely to go into labour – in the next five weeks. Earlier testing means your status may be more likely to change. Later testing means there’s a greater chance that your baby will arrive before the test result.
The test came back positive, what happens now?
Knowing you are a carrier is good news because with that knowledge you can take the appropriate preventative measures – by identifying Mums whose babies are at higher risk, and managing their pregnancy and delivery appropriately, most of these infections can be prevented.
A positive group B Strep result means that the pregnant woman should be offered intravenous antibiotics (penicillin or, for women who are allergic to penicillin, there are alternatives) from the start of labour or waters breaking and then usually at four-hourly intervals until delivery. Intravenous antibiotics given in labour to mums carrying group B Strep can reduce infection in babies by 90%!
Mums who have had a previous baby who developed group B Strep infection should ALWAYS be offered intravenous antibiotics from the start of labour in subsequent pregnancies (no testing needed).
If you’d like a ‘GBS Alert’ sticker to put on your hand-held pregnancy notes to remind your health professionals about the intravenous antibiotics in labour, you can download one from our website.
A helpful way to keep all this information in perspective is to remember MUMMY:
M – many women carry group B Strep naturally
U – usually causes no problems, but can be devastating
M – most common cause of serious infection in newborns and of meningitis in babies under 3 months
M – most group B Strep infections in babies are preventable
Y – your knowledge can help protect your baby
Dr Chris Steele MBE, family doctor and patron of charity Group B Strep Support says “Group B Strep infections can be devastating but can usually be prevented – get informed and protect your baby.”
Group B Strep Support is a UK charity dedicated to preventing life-threatening group B Strep infection in newborn babies. It provides information and support to families affected by group B Strep, and their health professionals. It calls for every pregnant woman to be informed about group B Strep and offered a sensitive test for group B Strep carriage to prevent unnecessary tragedies. An independent Medical Advisory Panel supports this charity.
Please sign and share the new group B Strep petition calling for pregnant women to be informed about group B Strep and offered GBS-specific tests in pregnancy.