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Updated: Jan 1, 2026
A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
Adherence to three different strategies to prevent early onset GBS infection in newborns
Diny G E Kolkman1, Marlies E B Rijnders2, Maurice G A J Wouters3
1Amsterdam UMC Vrije Universiteit Amsterdam, VU Medical Center, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands; Department of Child Health, TNO, P.O. Box 3005, Leiden, 2301 DA, The Netherlands.
Insights
Preventive strategies for early onset group B streptococcal (EOGBS) infection show low adherence, especially for women with risk factors. The risk-based and Dutch strategies are recommended for implementation despite suboptimal care observed.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Disease Prevention
Background:
- Early onset group B streptococcal (EOGBS) infection poses a significant threat to neonatal health, contributing to morbidity and mortality.
- Despite established preventive guidelines, a concerning lack of decrease in EOGBS incidence has been observed.
Purpose of the Study:
- To evaluate adherence to three distinct guideline-based preventive strategies for group B streptococcus (GBS).
- To identify the effectiveness of risk-based, combination, and Dutch GBS prevention strategies in a real-world setting.
Main Methods:
- A prospective, clustered experimental study involving 121 healthcare providers and 1562 pregnant women across three Dutch regions.
- Adherence was assessed by examining core elements: risk factor identification, maternal screening, intrapartum antibiotic prophylaxis, and neonatal observation.
- Data collection involved medical records, maternal questionnaires, and laboratory results.
Main Results:
- Overall adherence rates were high for the risk-based (90%) and Dutch (89%) strategies, but significantly lower for the combination strategy (57%).
- Critically, adherence to any strategy for women with identified EOGBS risk factors fell below 20% across all approaches.
- This indicates a widespread failure to implement recommended care for high-risk pregnancies.
Conclusions:
- Current preventive strategies are not optimally implemented, particularly for women with EOGBS risk factors.
- The risk-based and Dutch strategies demonstrate higher adherence and are recommended for future implementation.
- Further research is needed to understand and overcome barriers to optimal adherence and improve neonatal outcomes.
Problem:
Despite the introduction of preventive guidelines, no decrease in the incidence of early onset infection was observed.
Background:
Early onset group B streptococcal (EOGBS) infection is an important cause of neonatal morbidity and mortality.
Aim:
Our study was conducted to determine adherence to three guideline-based group B streptococcus (GBS) preventive strategies.
Methods:
A prospective experimental study clustered by obstetric collaboration region was performed between March 2013 and August 2014 among midwives, obstetricians and paediatricians in the Netherlands. At baseline, the three regions operated according to the Dutch preventive strategy (founded on the risk-based strategy) in order to prevent EOGBS infection, whereas in the study period they followed either the risk-based, the combination or the Dutch strategy. Adherence was measured prospectively per pregnant woman, using predefined core elements of each preventive strategy: identification of risk factors, maternal GBS screening, application of intrapartum antibiotic prophylaxis and observation of the child. Data about adherence to the core elements were collected from medical records, maternal questionnaires and laboratory test results.
Findings:
In the three regions, a total of 121 care providers and 1562 women participated. We found an overall adherence of 90% to the risk-based strategy, 57% to the combination strategy and 89% to the Dutch strategy. Adherence to a strategy in case women had EOGBS risk factors was below 20% in all strategies.
Discussion:
The majority of women with EOGBS risk factors did not receive the care prescribed by any of three preventive strategies and were not treated optimally.
Conclusion:
The risk-based and the Dutch strategy are the recommended strategies for implementation.
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