Group-B strep (GBS) is one of many types of bacteria which is found naturally living within the human body. It has a tendency to colonise the vagina and is found in up to 30% of women. Most of the time, it remains there unnoticed, peacefully co-existing with the multiple other organisms and causing no symptoms or problems whatsoever.
However, during child birth, GBS can become problematic and it is implicated in various types of infection in both mother and baby. In mothers, it can sometimes cause an infection within the uterus, usually during labour. Babies can develop two types of GBS infections, ‘early onset group-B strep’ (EOGBS) which can cause pneumonia shortly after birth or ‘late onset group-B strep’ (LOGBS) which can cause meningitis a bit later on. Unfortunately both of these can often be fatal.
Thankfully, the rate of EOGBS in babies is low with a rate in the UK of 0.5/1000 births. LOGBS is even less common with a rate in the UK of 0.3/1000 births.
Currently there is no vaccine to prevent GBS infection and in the UK, there is no screening program set up to detect GBS in mothers. The first time you might be aware that you have GBS might be after it is found incidentally if you have a vaginal swab or urine sample sent to the lab to investigate symptoms such as vaginal discharge or pain on passing urine. Some mothers also choose to get a vaginal swab to check for GBS privately.
If it is confirmed that you have GBS, the chance of your baby contracting the bacteria and developing EOGBS rises to 2.3/1000 births. For this reason, doctors will often recommend a course of IV antibiotics during labour to help prevent your baby developing EOGBS. Mothers who have had a child previously who developed either EOGBS or LOGBS will also be advised to have a course of antibiotics. Currently, it is not thought that there is an overall benefit to treating women not known to have GBS with antibiotics during labour.
It is important to remember that GBS is a naturally occurring bacteria in the vagina. There is no way to prevent yourself from getting it, so if you are found to have it, it’s not due to anything you have done or any treatment you have failed to take. It’s also important to know that vaginal cleansing or taking antibiotics during the run-up to your due date is not necessary as it will not reduce the risk of group-B strep infections in your baby.
After your baby is born, midwives will keep a close eye on your baby’s vital signs. Up to 90% of cases of EOGBS occur within the first 24 hours after birth but it can occur up to six days later. It usually presents with a fever, a change in vital signs, general irritability and abnormal behaviour. The midwife will decide if your baby is at high risk of developing EOGBS and will only let you go home once they consider that it is safe to do so. If you have been treated for GBS during labour, there is no reason not to breast feed and this should be encouraged as normal.
LOGBS can occur when babies are between six days and three months old, although it is very uncommon in babies over the age of one month. Antibiotics during labour do not prevent LOGBS so it’s essential that you seek medical help promptly if your baby is unwell.
Symptoms to look out for in your baby are irritability, high pitched crying/whimpering, poor feeding, excessive lethargy, floppiness, stiffness, jerking limbs, especially high or low temperature, especially high or low breathing rate and pale or blotchy skin. These symptoms are especially concerning if they persist or continue to get progressively worse.
If you have concerns, the first person to call should be your midwife as they will have all of the information regarding your pregnancy and labour. Alternatively, you can call your GP, or if it’s out of hours, call 111, 999 or attend A&E. If your baby is suspected of having a GBS infection, they will be given antibiotics as soon as possible.
Of course, it can be really difficult, especially for first time parents, to tell what is normal and what isn’t. The bottom line is that babies can become very unwell, very quickly so it’s important to trust your instincts and to seek expert assistance from a trained medical professional as soon as you feel things aren’t right.
Article written by Doctor Tom York. Tom has practised as a GP for four years to date and joined GPDQ in 2016. GPDQ is the UK’s first on-demand app for GP home visits.