Group B Streptococcus - What Does the Research Really Say?
In the US, most pregnant women have heard of Group B Streptococcus, but unfortunately know little true information about the condition and the real risks involved. The American College of Obstetricians and Gynecologists (ACOG) and the US Centers for Disease Control and Prevention (CDC) recommend that all pregnant women be screened between weeks 35 and 37 of their pregnancies to determine if they are carriers of GBS by taking a swab of the vaginal and rectal areas. About 30% of pregnant women are found to be colonized with GBS in one of both areas.
The recommended treatment by the CDC and ACOG is
intravenous
antibiotics during birthing because GBS can be passed from you to the
baby during delivery and cause sepsis (a blood infection), pneumonia,
and/or meningitis (an infection of the fluid and lining of the brain).
Why wouldn't a mother choose antibiotics?
To answer this question, we need to
look at what GBS truly is and why
it might not be such a good idea to recommend that a third of all pregnant women
expose themselves and their babies to antibiotics from
birth.
GBS is a bacterium that normally lives
in the intestinal tracts of many
healthy people. In truth, you should never be termed
“GBS
infected” but rather “GBS
colonized”. Remember that the
intestinal tract is composed of normal healthy bacteria, including
GBS. It is usually a transient condition that will come and
go through your pregnancy. You may swab positive at 36 weeks,
only to be negative again at 38 weeks.
GBS can cause problems only
when it is present in the genital area during birthing and delivery.
When this happens, there is a very small risk that the bacteria will be
passed on to the baby and become sick. Approximately 0.0225% of women
found to be GBS+ at 35 to 37 weeks who aren’t treated with
antibiotics
will have a baby who becomes ill. That's 1 in 4444 babies who
will become ill.
But here’s the most important point: in women who do receive
antibiotics, 0.0225% of babies will go on to become ill from
GBS. That's also 1 in 4444 babies who will become ill.
Antibiotics make absolutely no difference in the number of babies who will die from GBS.
In truth, there are many reasons you don’t want antibiotics for Group B Streptococcus, besides the fact that they don’t improve outcomes at all. These include:
• Increasing
occurrence of
antibiotic-resistant infections (“superbugs” -
think MRSA)
• Use of antibiotics has increased risk of developing other infections (sepsis & E. Coli included)
• Colonization of GBS is a poor indicator of which babies will become ill
• Antibiotics fail to prevent infection in 30% of cases
The most-commonly used antibiotic for treating
Group B Streptococcus
during birthing is
penicillin. Fewer bacteria currently show a resistance to penicillin
than to other antibiotics used to treat GBS. Ampicillin and
amoxicillin are virtually worthless for treating GBS due to overuse
that has now made Group B Streptococcus resistant to them.
It’s only a matter
of time until penicillin is also ineffective against
GBS. The superbug is on its way.
If you are allergic to penicillin, your options decrease. 29% of Group B Streptococcus strains are resistant to non-penicillin antibiotics. If you don’t know if you’re allergic or even if you’ve had it in the past, there’s a 1/10 chance of a mild reaction such as a rash, and a 1/10,000 chance of anaphylaxis, a life-threatening allergic reaction.
Two in 10,000 babies may be saved by antibiotics during birth, but this comes at the cost of giving 1/3 of all pregnant women antibiotics. The risks of developing a superbug are greater than the chances of saving your baby with antibiotics. This also doesn’t take into account how many other infections babies given antibiotics may develop other than Group B Streptococcus.
What are the risk factors for mothers with GBS?
There are three significant factors that place your baby at increased risk of infection: fever during birthing, water breaking 18 hours or more before birthing (prolonged rupture of membranes, or PROM), and/or birthing or broken water before 37 weeks. Other factors that can contribute to a newborn's risk of contracting Group B Streptococcus infection include age, ethnicity, and medical criteria, such as the following: being born to a mother who is less than 20 years old, being African American, large amounts of GBS bacteria in the vaginal tract, and having a previous baby with GBS disease.
What are the symptoms of GBS infection in a baby?
There are two forms of Group B Streptococcus infection: early and late onset. In early-onset GBS disease, your baby will become ill within seven days of birth. In severe early-onset GBS infection, about 6 percent of babies will die from complications of the infection. Full-term babies are less likely to die; 2-8% suffer fatal complications. Premature babies have mortality rates of 25-30%. Late-onset GBS infection is more complicated and may not have anything to do with whether you had GBS during birthing. It occurs between seven days and three months of age.
Symptoms of early-onset Group B Streptococcus
infection include any of
the following:
fever or abnormally low body temperature, jaundice (yellowing of the
skin and whites of the eyes), poor feeding, vomiting, seizures,
difficulty in breathing, swelling of the abdomen, and bloody stools.
The most common symptom is difficulty breathing, which is also the most
common complication in babies whose mothers choose drugs during
birthing. Since these symptoms can occur in so many
circumstances not related to GBS, a C-Reactive protein test can be
given to a symptomatic baby to reveal the presence of an active
infection.
Are there alternatives to antibiotics?
Even though Group B Streptococcus is a transient infection, without an active effort to eradicate the GBS colonization, it is likely that you will still be colonized after 37 weeks. We will see better outcomes by simply focusing on reducing colonization rather than treating it after the fact.
There are many probiotic, natural remedies that
focus on restoring a
healthy vaginal flora balance, reducing bacterial overgrowth, and
directly reducing the bacterial concentration.
These treatments can begin at 32 weeks rather than waiting for a
positive culture. Another option is to NOT screen for beta
strep during
pregnancy, but to follow a strict protocol during birthing if you have
the following risk factors: 1) fever over 38 degrees Celsius, 2)
pre-term birthing < 37 weeks, 3) prolonged rupture of membranes
> 18 hours, 4) multiple births, and 5) previously-infected
baby. In these cases antibiotics may be indicated.
Those infants who are symptomatic (fever, fast breathing, poor feeding,
high pitched cry) can be evaluated for sepsis and given antibiotics for
48-72 hours. Alternately, you can request a C-reactive
protein test to determine the presence of an active infection before
giving antibiotics to the baby.
Treatment Options
Below are a series of treatment options for you to consider:
TREATMENT
OPTION #1:
If you have a heavy colonization, use EHB capsules by NF
Formulas given over a 10-day period (6 caps per day), and Tea tree oil
vaginal suppositories 3-4 times daily for that time. This can
be done on a small size tampon or a cotton ball, whichever is more
comfortable. Colonization is measured on a range from 1-4
with 1 being minimal and 4 being heavy colonization.
TREATMENT
OPTION #2:
Take 500mg of Vitamin C every 4 waking hours, 1 EHB (NF
Formulas) capsule every 4 waking hours, Propolis 4x daily, and insert a
tampon soaked in 2% Tea Tree oil solution (2%Tea Tree essential oil,
98% Olive oil). Leave the tampon in for 4 hours each day for
6 days.
TREATMENT
OPTION #3:
Take 3 caps of Congaplex by Standard Brands 3 times a day for
a week, then re-culture. If still positive, take 1 cap per day until
the end of pregnancy.
TREATMENT
OPTION #4:
At 32 weeks, begin to take a supplement of 500 mg of Vitamin C
and one cup of burdock root and Echinacea root infusion. To prepare the
infusion, steep one-half ounce of each of the herbs in four cups of
boiling water for two hours. Strain and take the above dose,
storing the rest in the refrigerator for the next day.
TREATMENT
OPTION #5
Drink 3 teaspoons of Colloidal Silver, which is silver
suspended in water, per day between meals. Hold the liquid in
your mouth a few minutes before swallowing. Colloidal Silver
can be purchased in most health food stores. It is antibiotic in nature
and safe in pregnancy.
TREATMENT
OPTION #6:
Use of oral antibiotics: 3 a day starting at week 37 and then
one a day until birthing begins. When birthing begins, take one every
4-6 hours until the baby is born. (It seems like a lot, but it lets you
avoid the cascade of interventions that IV antibiotics brings at the
hospital).
TREATMENT OPTION
#7:
Treat with antibiotics by intramuscular injection (IM) before
the birth. This method will cover you for 30 days after the injections
(4 injections total to give the full dose).
TREATMENT
OPTION #8:
Take 1/3 teaspoon of echinacea and astragalus tinctures twice
daily. You can get dried astragalus in the herb department of health
food stores. Cook two strips into a pot of rice or soup 2-3
times per week Remove the strips when done cooking and eat the rice or
soup. Astragalus is an immune system tonic used in Chinese
medicine.
TREATMENT
OPTION #9:
Make a garlic elixir by blending 1/2 cup of honey, 1/4 cup of
apple cider vinegar, and half a bulb of fresh garlic until liquified.
Take 1/2 teaspoon up to twice daily. Season to taste with
honey or vinegar.
Return to Top of Group B Streptococcus
PREVENTION TIPS
• Breastfeed immediately and frequently. The colostrum is the best antibiotic treatment your baby could ever get.
• Refuse vaginal exams
• DO NOT permit artificial rupture of membranes.
Sample Birth Plan Language
After you have assessed your situation and decided upon your preferred course of treatment, you must add it either in the body of your birth plan or as an addendum. Here is some sample language you may wish to include:
I (will/will not) be screened for Group B Streptococcus.
If the result is negative, the only precautions
will be to closely
monitor birthing for the above risk factors and monitor the baby after
childbirth for possible signs of infection.
If any of the risk factors (fever over 38 degrees Celsius, pre-term birthing < 37 weeks, prolonged rupture of membranes > 18 hours) occur, mother will consent to alternative treatment options other than those listed above in the best interest of the health of the baby.
If the result is positive the treatment of choice is (list treatment option #):_______
Mother’s Signature
Date
Care
Provider‘s Signature
Date
References
F. Smaill, "Intrapartum Antibiotics for Group B Streptococcal Colonization," Cochrane Database Syst Rev 2 (2000): CD000115: www.ncbi.nlm. nih.govl.S. D. Manning et al., "Correlates of Antibiotic-Resistant Group B Streptococcus Isolated from Pregnant Women," Obstetric Gynecology 101, no. 1 (2003): 74-79
R. K. Edwards et al., "Intrapartum Antibiotic Prophylaxis 2: Positive Predictive Value Antenatal Group B Streptococci Cultures and Antibiotic Susceptibility of Clinical Isolates," Obstetric Gynecology 100, no. 3 (2002): 540-544.
M. Dabrowska-Szponar and J. Galinski. "Drug Resistance of Group 9 Streptococci," Pol Merkuriusz Lek 10, no. 60(2001): 442-444.
M. L. Bland et al., "Antibiotic Resistance Patterns of Group B Streptococci in Late Third Trimester Rectovaginal Cultures," American Journal of Obstetric Gynecology 184. no, 6 (2001): 1125-1126.
T. B. Hyde ct al., "Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta," Pediatrics 110, no. 4 (2002): 690-695.
R. S. McDuffie Jr. et al., "Adverse Perinatal Outcome and Resistant Enterobacteriaceae after Antibiotic Usage for Premature Rupture of Membranes and Group B Streptococcus Carriage," Obstetric Gynecology 82, no. 4, pt. 1 (1993): 487-489.
C. V. Towers and G. G. Briggs, "Antepartum Use of Antibiotics and Early-Onset Neonatal Sepsis: The Next Four Years," American Journal of Obstetric Gynecology 187, no. 2 (2002): 495-500.
S. J. Schrag et al., "A Popular/on Based Comparison of Strategies Co Prevent Early-Onset Group B Streptococcal Disease in Neonates," New England Journal of Medicine 347 (2002): 233-239.
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