This pamphlet explains

how GBS may affect a newborn testing for GBS treatment of GBS treatment in special situations

If you are GBS positive, treatment during labor and delivery may help prevent early-onset GBS infection in your baby.

What is GBS?

GBS is one of the many bacteria that live in the body and usually do not cause serious illness. It is found in the digestive, urinary, and reproductive tracts of men and women. In women, it can be found in the vagina and rectum. GBS is not a sexually transmitted disease. Also, although the names are similar, GBS is different from group A streptococcus, the bacteria that causes “strep throat.”

A person who has the bacteria but shows no symptoms is said to be colonized. The number of bacteria that a person has may change over time. A person colonized with a large number of bacteria may have low levels of bacteria months or years later. It also is possible for the number of bacteria to decrease to levels that cannot be detected.

Most pregnant women who are colonized with GBS have no symptoms or health effects. A small number may develop a urinary tract infection caused by GBS. The most serious health effect is that a woman colonized with GBS late in her pregnancy can pass it to her baby. For this reason, women are tested for GBS late in pregnancy. If GBS is present, a woman will receive treatment during labor.

Effects on the Baby

There are two types of GBS infections in babies:

1. Early–onset infections—These infections develop right after delivery when the baby passes through the birth canal colonized with GBS. Early–onset infections occur within the first 7 days after birth. Most occur within the first 6 hours after birth. Only a few babies who are exposed to GBS develop an infection. Certain factors, such as preterm birth, may increase the risk of a baby becoming infected. The most common problems caused by early–onset GBS infections are lung infections, blood infection, and meningitis.
2. Late–onset infections—These infections occur after the first 7 days of life. Late–onset infections may be passed from the mother to the baby during birth or they may be caused by contact with other people who are colonized with GBS. Late–onset infection can lead to meningitis and other diseases, such as pneumonia.

Both types of infections can be serious. GBS infections cause death in about 5% of infected babies.

Testing for GBS

To prevent early–onset GBS infection, women are tested for GBS late in pregnancy, between weeks 35 and 37. The test is called a culture. In this test, a swab is used to take a sample from the woman’s vagina and rectum. This procedure is quick and should not be painful. The sample is sent to a lab where it is grown in a special substance. It may take up to 2 days to get the results.

If you had a previous baby with GBS infection or if you had a urinary tract infection caused by GBS during this pregnancy, you are at high risk for passing GBS on to your baby during labor and delivery. You will receive treatment during labor. A test is not needed to confirm this.

If you had a positive GBS test result in a prior pregnancy, you need to be tested again during each pregnancy. You may no longer have the bacteria. If your test result is negative, you do not need treatment during labor and delivery. If your result is positive, you will need treatment.

Signs and Symptoms of Late-Onset Infection Late-onset GBS infection most commonly causes meningitis. In infants, the signs and symptoms of meningitis can be hard to spot. If your baby has any of these signs and symptoms, call your pediatrician: Slowness or inactivity Irritability Poor feeding Vomiting High fever

Treatment

If results of the culture test are positive, showing that GBS is present, you will receive treatment with antibiotics during labor to help prevent GBS from being passed to your baby. Antibiotics help get rid of some of the bacteria that can harm the baby during birth. The antibiotics work only if they are given during labor or after the amniotic sac has ruptured (your “water” has “broken”), but before your baby is delivered. If treatment is given earlier in pregnancy, the bacteria may regrow and be present during labor.

Although this treatment helps prevent early–onset GBS infection, it does not always prevent late–onset GBS infection. Babies may pick up GBS from people they come in contact with or through other means. The antibiotic given during birth does not protect a baby from these kinds of GBS infections. It is important to know the signs and symptoms of late–onset infection (see box). If your baby has any of these signs or symptoms, contact your pediatrician right away.

Penicillin is the antibiotic that is most often given to prevent early–onset GBS infection in newborns. If you are allergic to penicillin, tell your health care provider. You will receive a different antibiotic. If you have had a severe reaction to penicillin called anaphylaxis, the bacteria will need to be tested to determine the choice of antibiotic.

Although most of the time there are no side effects to penicillin, 1 out of every 10 women may have a mild rash in response to this treatment. The rash may occur within 1–2 weeks after treatment. Rarely, a woman may have a severe allergic reaction and require emergency treatment. Inform your doctor if you develop a rash after treatment.

Special Situations

Do You Need Treatment for GBS During Labor and Delivery? Yes, if you have had a previous baby with GBS infection you have had a urinary tract infection with GBS during this pregnancy you have a positive culture test result during this pregnancy your GBS status is not known (you did not have a GBS culture test during this pregnancy, the test was not complete, or the results are not known) and any of the following occur: you go into labor at less than 37 weeks of pregnancy your water breaks 18 hours or more before delivery you have a fever during labor No, if you have a planned cesarean delivery, and it is done before your labor starts or water breaks you have a negative GBS culture test result during this pregnancy

Women who have planned a cesarean birth do not need to be given antibiotics during delivery (if their labor has not begun or their water has not broken), whether they are colonized with GBS or not. However, these women should still be tested for GBS because labor may occur before the planned cesarean birth.

Pregnant women who do not know if they are GBS positive or have not yet been tested when labor starts should be given antibiotics in specific situations (see box). For example, if a woman goes into labor or her water breaks too early (before 37 weeks of pregnancy), she may not have been tested for GBS. She may be given antibiotics and be tested for the bacteria as a precaution. If the test result is negative after 48 hours, the antibiotics may be stopped.

Finally...

GBS can cause problems in newborns. Pregnant women are tested for GBS late in pregnancy. If you are GBS positive, treatment during labor and delivery may help prevent early–onset GBS infection in your baby. It is important to tell your health care provider about your GBS status in past pregnancies and whether you have had a baby infected with GBS.

Glossary

Amniotic Sac: Fluid–filled sac in the mother’s uterus in which the fetus develops.

Anaphylaxis: An allergic reaction with symptoms ranging from hives and itching to breathing problems and shock. It can be life-threatening for some people.

Antibiotics: Drugs that treat infections.

Cesarean Birth: Delivery of a baby through an incision made in the mother’s abdomen and uterus.

Colonized: Having bacteria in your body that could cause illness, but having no symptoms of the disease.

Meningitis: Inflammation of the membranes of the brain or spinal cord.

Preterm: Born before 37 weeks of pregnancy.

Sexually Transmitted Disease: A disease that is spread by sexual contact, including chlamydial infection, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

This Patient Education Pamphlet was developed by the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women’s health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as “superior.” To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate.

Copyright © December 2009 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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