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Perinatal complications in group B streptococcal carriers: a longitudinal study of prenatal patients
Insights
Prenatal screening for group B streptococcus (GBS) carriers shows increased overall morbidity. However, the low risk for specific complications suggests routine GBS testing may not be justified without further evidence.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Infectious Disease Epidemiology
Background:
- Group B Streptococcus (GBS) is a significant concern in perinatal health.
- Prenatal detection and eradication strategies aim to reduce GBS-related morbidity.
- The precise risk of perinatal complications for prenatal GBS carriers remains unclear.
Purpose of the Study:
- To define the risk of perinatal complications in prenatal carriers of group B streptococci.
- To compare morbidity rates between GBS carriers and non-carriers in a prenatal population.
- To evaluate the predictive value of prenatal GBS screening for adverse outcomes.
Main Methods:
- Serial cultures were performed on 718 prenatal patients.
- Morbidity outcomes were compared between GBS carriers and non-carriers.
- Statistical analysis was used to identify significant differences in complication rates.
Main Results:
- Prenatal GBS carriers had higher rates of collective morbidity, low birth weight, and premature rupture of membranes with low birth weight.
- Maternal pelvic infection and neonatal sepsis were elevated at delivery in colonized women, but not specifically in prenatal carriers.
- The predictive value of a positive prenatal GBS culture for any complication did not exceed 8%.
Conclusions:
- Overall morbidity is greater in prenatal GBS carriers compared to non-carriers.
- The risk for specific serious perinatal complications is too low to warrant routine prenatal GBS detection.
- Further prospective studies are needed to establish the value of GBS screening programs.
Abstract:
Although prenatal group B streptococcal detection and eradication have been proposed to prevent morbidity, the risk of perinatal complications in prenatal carriers of group B streptococci has not been defined. We evaluated 718 prenatal patients with serial cultures to compare morbidity in carriers and noncarriers. Complications occurring more frequently (p less than or equal to 0.05) in prenatal carriers were: collective morbidity, low birth weight, and premature rupture of membranes associated with low birth weight. Maternal pelvic infection and neonatal sepsis were increased in colonized women at delivery but not in prenatal carriers. Ninety-two percent of colonized women were not delivered of low birth weight infants. No carriers delivered vaginally or by repeat cesarean section became infected. Neither inoculum size nor chronic carriage was related to morbidity. The predictive value of a positive prenatal culture did not exceed 8% for any of the complications. We concluded that overall morbidity in carriers of group B streptococci is greater than in noncarriers; however, the risk for specific complications is too low to justify routine testing for detection of group B streptococci until prospective study demonstrates the value of such programs.