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Updated: Dec 31, 2025
A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset
G F Hasperhoven1, S Al-Nasiry2, V Bekker3
1Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Insights
Universal screening for early-onset group B streptococcal (GBS) disease in pregnant women significantly reduces infant infections compared to risk-based protocols. This approach lowers GBS disease incidence without substantially increasing antibiotic use.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Diseases
Background:
- Early-onset group B streptococcal (EOGBS) disease poses a significant global threat to newborns, causing severe illness and death.
- Current strategies for preventing vertical transmission of GBS include screening-based and risk-based protocols, but uniform criteria for antibiotic prophylaxis are lacking.
Purpose of the Study:
- To compare the effectiveness of universal screening versus risk-based protocols in preventing EOGBS disease in neonates.
Main Methods:
- A meta-analysis of seventeen eligible studies was conducted.
- Risk ratios (RR) and 95% confidence intervals (CI) were calculated using Mantel-Haenszel analyses with random effects.
Main Results:
- Universal screening was associated with a significantly reduced risk of EOGBS disease compared to risk-based protocols (RR 0.43, 95% CI 0.32-0.56).
- Screening also showed a reduced risk compared to no policy (RR 0.31, 95% CI 0.11-0.84).
- Risk-based protocols did not demonstrate a significant effect compared to no policy (RR 0.86, 95% CI 0.61-1.20), and screening did not increase antibiotic administration rates.
Conclusions:
- Screening-based protocols are more effective in reducing EOGBS disease incidence than risk-based protocols.
- These findings suggest that universal screening is a valuable strategy for preventing neonatal GBS disease without excessive antibiotic exposure, informing future public health policies.
Background:
Early-onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), whereas others employ risk-based protocols.
Objectives:
To compare the effectiveness of screening-based versus risk-based protocols in preventing EOGBS disease.
Search Strategy:
Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based.
Selection Criteria:
Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk-based protocols with each other or with controls.
Data Collection And Analysis:
Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects.
Main Results:
Seventeen eligible studies were included. In this meta-analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk-based protocols (ten studies, RR 0.43, 95% CI 0.32-0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61-1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%).
Conclusions:
Screening-based protocols were associated with lower incidences of EOGBS disease compared with risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking.
Tweetable Abstract:
Meta-analysis: general screening is associated with lower rates of early-onset group B strep. neonatal sepsis compared with risk-based protocols.
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