Early onset Group B Streptococcus (Group B Strep) infection poses serious health risks, especially for newborn babies, and continual efforts are needed to ensure a full understanding of the process of infection and how its harmful effects can be prevented.
Group B Strep is a common type of bacteria and up to two in five people have it living in their body; this is often known as ‘carrying’ Group B Strep. It is normally carried in the gut and for up to 25% of women, in the vagina. Usually there are no symptoms or side-effects and you would not know that you carry Group B Strep unless a test has detected it.
If a pregnant woman is carrying Group B Strep when she gives birth, there is around a 50% chance her baby will be exposed to the bacteria. Most babies will not be affected, but without preventative medicine, there is a 1-2% chance of the baby falling seriously ill with meningitis, sepsis or pneumonia, as their immune systems are immature. Group B Strep can also very rarely cause an infection during pregnancy and before labour starts.
Approximately one in every 1,000 babies born in the UK develops a Group B Strep infection. With prompt treatment, most babies make a full recovery. It is estimated that one in 19 babies who have a Group B Strep infection die and one in 14 survivors suffer long-term mental and physical problems, including brain injury, cerebral palsy, learning difficulties and epilepsy.
Group B Strep can cause sepsis, pneumonia and meningitis. It is the most common cause of bacterial meningitis in babies younger than three months, and can lead to life-long disability.
Treatment and testing
Mothers-to-be can be tested for Group B Strep during weeks 35-37 of pregnancy. If detected, the current guidelines recommend that a pregnant woman should be treated with intravenous antibiotics (given via a drip) during the labour process. This significantly reduces the risk of the baby developing a Group B Strep infection around birth. Parents will sometimes be advised to stay in hospital for at least 12 hours after the birth so that the baby can be monitored.
Tests for Group B Strep are not routinely carried out during pregnancy in the UK. The current Royal College of Obstetricians and Gynaecologists’ guidelines that refer to the prevention of early onset neonatal Group B Strep infection were updated in 2017. These guidelines recommend a ‘risk factor’ approach to establish whether women should be offered antibiotics during their labour to prevent a Group B Strep infection in their newborn babies. The UK National Screening Committee does not recommend universal antenatal screening for Group B Strep.
Therefore, currently testing only takes place in select circumstances. A test may be carried out during pregnancy if a mother-to-be carried Group B Strep in a previous pregnancy, and her baby was not ill with a Group B Strep infection.
Unfortunately, the current position means that in most cases at least one baby born into a family must suffer from Group B Strep infection, and potential harm, before that family has the opportunity to be tested on the NHS in future pregnancies.
Figures gathered from a Freedom of Information Request from the University Hospital Southampton NHS Foundation Trust demonstrate that between 2013 and 2017 the numbers of babies experiencing an adverse outcome, meaning either disability or death, from Group B Strep remained static, meaning that there is much more work to be done.
Obtaining a private test
The Enriched Culture Medium (ECM) test is the best test available for detecting Group B Strep bacteria. This method is not widely available on the NHS, despite being recommended by both Public Health England and the Royal College of Obstetricians and Gynaecologists. It can however be conducted privately, normally for around £35, and is offered at some clinics. The test can also be carried out in the comfort of your own home. Conducting this test is likely to reduce the risk that a baby will suffer from a Group B Strep infection and the associated complications.
It is important that if a mother-to-be carries out the test and finds out she is a carrier of the Group B Strep bacteria, she notifies her midwife so her labour can be managed accordingly.
The future for Group B Strep management
In May 2019 a landmark trial was announced with the aim of improving prevention of potentially life-threatening infection caused by Group B Strep. The £2.8 million National Institute for Health Research (NIHR) funded study will measure the effectiveness of two tests to identify Group B Strep bacteria in late pregnancy or labour, compared with the current approach of identifying women with ‘risk factors’ for their baby developing the infection. It will take place in 80 hospitals in England, Wales and Scotland and the results will inform future pregnancy care policy in the UK.
Helen Hammond, senior associate in the clinical negligence team at Penningtons Manches Cooper, who specialises in cases where a baby dies at or shortly after birth, or is left with a lifelong injury because of their care, comments: “This trial offers a real opportunity to identify whether the current approach to management of Group B Strep provides the safest outcomes for newborn babies. We have worked with families whose lives have been devastated by the injuries their child suffered after a Group B Strep infection and welcome any research that has the potential for positive changes to make the time around birth safer for babies.”
Group B Strep Support offers help and guidance, including the best places to go for the ECM test, on its website at www.gbss.org.uk