Perinatology.  2018 Dec;29(4):147-152. 10.14734/PN.2018.29.4.147.

Pregnancy and Neonatal Outcomes of Group B Streptococcus Infection in Preterm Births

• Lee YH
• Lee YJ
• Jung SY
• Kim SY
• Son DW
• Seo IH

• KMID: 2430216
• DOI: http://doi.org/10.14734/PN.2018.29.4.147

Abstract

OBJECTIVE
This study examines whether maternal group B Streptococcus (Streptococcus agalactiae, GBS) infection was associated with preterm births and premature neonatal outcomes.
METHODS
Maternal and neonatal outcomes were examined among singleton pregnant women with preterm birth (from 24+0 weeks to 36+6 weeks) who were tested for GBS (n=203) during the pregnancy. Data were collected retrospectively from the medical records of women who delivered at our hospital from January 2015 to February 2017. We compared obstetrical factors (causes of preterm birth) and neonatal (gestational age at delivery, birth weight, Apgar score 1 min/5 min, hospitalization period, duration of mechanical ventilation, neonatal C-reactive protein within three days, and other complication [respiratory distress syndrome, neonatal deaths]) outcomes between GBS-infected and non-infected pregnant women.
RESULTS
There were 203 singleton pregnant women included in the study, 25 of whom were confirmed to have a GBS infection during the pregnancy. There was no difference in neonatal outcomes by GBS status. Preterm premature rupture of membranes (pPROM), as an obstetric factor, was associated with GBS infection (P=0.022). GBS infection raised the risk of pPROM by 3.6 times (odds ratio 3.648, 95% confidence interval 1.476-9.016, P=0.005).
CONCLUSION
GBS infection in preterm birth was associated with pPROM but did not result in adverse neonatal outcomes. Continuous attention and evaluation of GBS infection, a major cause of neonatal sepsis and pneumonia, are needed.

Keyword

Streptococcus agalactiae; Premature birth; Fetal membranes; Premature rupture

MeSH Terms

Apgar Score
Birth Weight
C-Reactive Protein
Extraembryonic Membranes
Female
Hospitalization
Humans
Medical Records
Membranes
Pneumonia
Pregnancy*
Pregnant Women
Premature Birth*
Respiration, Artificial
Retrospective Studies
Rupture
Sepsis
Streptococcus agalactiae
Streptococcus*
C-Reactive Protein

Reference

1). Edwards MS., Nizet V., Baker CJ. Group B Streptococcal Infections. In: Remington JS, Klein JO, Wilson CB, et al. editors. Infectious Diseases of the Fetus and Newborn Infant. 7th ed, Philadelphia, Elsevier Saunders, 2011, p. 419–69.

2). Eichenwald EC. Perinatally transmitted neonatal bacterial infections. Infect Dis Clin North Am. 1997. 11:223–39.

3). Verani JR., McGee L., Schrag SJ. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010. 59(RR-10):1–36.

4). Regan JA., Klebanoff MA., Nugent RP., Eschenbach DA., Blackwelder WC., Lou Y, et al. Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group. Am J Obstet Gynecol. 1996. 174:1354–60.

5). Krohn MA., Hillier SL., Baker CJ. Maternal peripartum complications associated with vaginal group B streptococci colonization. J Infect Dis. 1999. 179:1410–5.

6). Phares CR., Lynfield R., Farley MM., Mohle-Boetani J., Harrison LH., Petit S, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008. 299:2056–65.

7). Koenig JM., Keenan WJ. Group B streptococcus and early-onset sepsis in the era of maternal prophylaxis. Pediatr Clin North Am. 2009. 56:689–708. Table of Contents.

8). Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am. 2004. 51:939–59. viii-ix.

9). Heath PT., Balfour G., Weisner AM., Efstratiou A., Lamagni TL., Tighe H, et al. Group B streptococcal disease in UK and Irish infants younger than 90 days. Lancet. 2004. 363:292–4.

10). Schrag S., Gorwitz R., Fultz-Butts K., Schuchat A. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep. 2002. 51(RR-11):1–22.

11). Van Dyke MK., Phares CR., Lynfield R., Thomas AR., Arnold KE., Craig AS, et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med. 2009. 360:2626–36.

12). Benitz WE., Gould JB., Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics. 1999. 103:e77.

13). Hong JS., Choi CW., Park KU., Kim SN., Lee HJ., Lee HR, et al. Genital group B Streptococcus carrier rate and serotype distribution in Korean pregnant women: implications for group B streptococcal disease in Korean neonates. J Perinat Med. 2010. 38:373–7.

14). Lee BK., Song YR., Kim MY., Yang JH., Shin JH., Seo YS, et al. Epidemiology of group B streptococcus in Korean pregnant women. Epidemiol Infect. 2010. 138:292–8.

15). Zhang LX., Sun Y., Zhao H., Zhu N., Sun XD., Jin X, et al. A bayesian stepwise discriminant model for predicting risk factors of preterm premature rupture of membranes: a case-control study. Chin Med J (Engl). 2017. 130:2416–22.

16). Yoon IA., Jo DS., Cho EY., Choi EH., Lee HJ., Lee H. Clinical significance of serotype V among infants with invasive group B streptococcal infections in South Korea. Int J Infect Dis. 2015. 38:136–40.

17). Persson E., Berg S., Trollfors B., Larsson P., Ek E., Backhaus E, et al. Serotypes and clinical manifestations of invasive group B streptococcal infections in western Sweden 1998-2001. Clin Microbiol Infect. 2004. 10:791–6.

18). Lachenauer CS., Kasper DL., Shimada J., Ichiman Y., Ohtsuka H., Kaku M, et al. Serotypes VI and VIII predominate among group B streptococci isolated from pregnant Japanese women. J Infect Dis. 1999. 179:1030–3.

19). El Aila NA., Tency I., Claeys G., Saerens B., Cools P., Verstraelen H, et al. Comparison of different sampling techniques and of different culture methods for detection of group B streptococcus carriage in pregnant women. BMC Infect Dis. 2010. 10:285.

20). Benitz WE., Gould JB., Druzin ML. Antimicrobial prevention of early-onset group B streptococcal sepsis: estimates of risk reduction based on a critical literature review. Pediatrics. 1999. 103:e78.

21). Ganor-Paz Y., Kailer D., Shechter-Maor G., Regev R., Fejgin MD., Biron-Shental T. Obstetric and neonatal outcomes after preterm premature rupture of membranes among women carrying group B streptococcus. Int J Gynaecol Obstet. 2015. 129:13–6.