Group B Strep
Group B Strep in pregnancy and newborn babies – what you need to know
The following information is from the patient information leaflet, Group B Streptococcus (GBS) in pregnancy and newborn babies, developed by the RCOG with charity Group B Strep Support, published in December 2017
The Royal College of Obstetricians and Gynaecologists and Group B Strep Support have published updated patient information to help women and their partners understand the risks of Group B Strep infection in babies, and available options.
WHAT IS GROUP B STREP?
Group B Streptococcus (GBS or Strep B) is a common bacterium carried in the vagina and rectum of 2-4 in 10 women (20-40%) in the UK. It is not a sexually transmitted disease. Most women carrying GBS have no symptoms; carrying GBS is not harmful to you. However, GBS can affect your baby around birth and occasionally causes serious infection.
WILL I BE TESTED DURING PREGNANCY FOR GROUP B STREP?
The NHS does not routinely offer all pregnant women screening for GBS. For more information about available tests, visit Group B Strep Support’s website at www.gbss.org.uk/TestingforGBS
HOW IS GROUP B STREP FOUND?
Group B Strep is sometimes found during pregnancy when you have vaginal or rectal swabs, or a urine test.
No treatment is recommended when GBS is found on a vaginal or rectal swab before labour starts, although a urine infection caused by GBS should be treated with antibiotic tablets straight away.
WHAT COULD GROUP B STREP MEAN FOR MY BABY?
Many babies come into contact with Group B Strep around birth. The vast majority of these babies will not become ill. However, if you carry GBS, there is a small chance your baby will develop GBS infection, become seriously ill or even die.
Around 1 in every 1750 babies born in the UK and Ireland is diagnosed with early-onset (in the first week of life) GBS infection. The infections GBS most commonly cause in babies are sepsis (infection of the blood), pneumonia (infection in the lungs), and meningitis (infection of the fluid and lining around the brain).
Although GBS infection can make your baby very unwell, with prompt treatment most babies will recover fully. However, of the babies who develop early-onset GBS infection, 1 in 19 (5.2%) will die, and of the survivors 1 in 14 (7.4%) will have a long-term disability.
WHAT PUTS MY BABY AT A HIGHER RISK OF DEVELOPING GBS INFECTION?
Infection is more likely to happen if:
- Your baby is born preterm (before 37 completed weeks of pregnancy)
- You have previously had a baby affected by GBS infection
- You have a high temperature or other signs of infection during labour
- You have a positive urine or swab test for GBS in this pregnancy
- Your waters have broken more than 24 hours before your baby is born
HOW CAN THE RISK TO MY BABY BE REDUCED?
You should be offered antibiotics through a drip during labour if you have had a GBS-positive swab or urine test during your pregnancy from an NHS or other accredited laboratory (see www.gbss.org.uk/TestingforGBS for further information).
You should also be offered the antibiotics if you have previously had a baby diagnosed with
GBS infection, if labour starts before 37 weeks of pregnancy, or if you show signs of infection in labour.
If GBS was found in a previous pregnancy and your baby was unaffected, there is a 1 in 2 (50%) chance you will be carrying it this pregnancy. To help you choose whether to have antibiotics in labour, you can have a GBS-specific swab test (the enriched culture medium or ECM test) when you are 35-37 weeks pregnant. If positive, you will be offered antibiotics in labour. If negative, you may choose not to have antibiotics.
WHAT ARE MY OPTIONS FOR WHERE I CAN HAVE MY BABY?
You should discuss your planned place of birth with your healthcare professional during pregnancy. If you choose to have antibiotics, they will be given through a drip. It may not always be possible to arrange this at home or in some midwifery-led units.
IF GBS HAS BEEN FOUND, WHEN SHOULD I HAVE ANTIBIOTICS?
Contact your healthcare professional as soon as you go into labour or your waters break: it is important you start the antibiotics as soon as possible.
When given through a drip during labour, the antibiotics reduce the risk of your baby developing early onset GBS infection from around 1 in 400 to 1 in 4000.
CAN ANTIBIOTICS IN LABOUR CAUSE ANY HARM?
Your healthcare professional should discuss with you the benefits and risks of antibiotics in labour to prevent early-onset GBS infection in your baby.
Some women may experience temporary side effects such as feeling sick or having diarrhoea. Women can be allergic to certain antibiotics and in rare cases the reaction may be severe. Tell your healthcare professional if you are allergic to penicillin or other medications.
WHAT ARE THE SIGNS OF GBS INFECTION IN MY BABY?
Most babies who develop GBS infection become unwell in the first week of life, usually within 12-24 hours of birth. Signs of early onset GBS infection may include:
- grunting, noisy breathing, moaning, seeming to be working hard to breathe when you look at their chest or tummy, or not breathing at all
- be very sleepy and/or unresponsive
- be crying inconsolably
- be unusually floppy
- not feeding well or not keeping milk down
- have a high or low temperature and/or their skin feels too hot or cold
- have changes in their skin colour (including blotchy skin)
- have an abnormally fast or slow heart rate or breathing rate
- have low blood pressure*
- have low blood sugar*
*Identified by tests done in hospital
If you notice any of these signs or are worried about your baby, you should urgently contact your healthcare professional and also mention GBS. Early diagnosis and treatment of GBS infection is important – delay could be very serious or even fatal.
Download the joint GBSS-RCOG patient information on Group B Streptococcus (GBS) in pregnancy and newborn babies from www.gbss.org.uk/JointLeaflet
This information has been developed by the RCOG and Group B Strep Support, based on current guidelines.
For more information about RCOG’s Patient Information, visit https://www.rcog.org.uk/en/patients/patient-leaflets
For more information about Group B Strep Support and their work, visit www.gbss.org.uk