I Tested GBS Positive, Now What?

Pregnant women are tested for Group B Streptococcus (Group B Strep, GBS) during the last trimester of pregnancy – typically around 35-37 weeks gestation. Most providers solely recommend IV antibiotics during labor, but some women express concerns regarding side effects of this treatment, including being tied to an IV during labor, upsetting mom or baby’s microbiome, diarrhea, allergic reactions, and antibiotic resistance. In order to make truly informed decisions, you need to know risks and benefits for all of your options.



Why do we test for GBS and what are the risks?


GBS is a bacteria that can inhabit the intestines and then travel down to the rectum, vagina, and urinary tract. It is estimated that 10-30% of pregnant women are GBS carriers (1). Most people who carry GBS will never have any symptoms, so there is very little concern within the general population. There is however, a small risk of complications if GBS is passed on to a newborn. This is why OB GYNs and midwives in the United States generally test all pregnant women for GBS around 35-37 weeks pregnant. According to the CDC, 1-2% of all babies delivered to untreated, GBS positive mothers will experience early onset (within 7 days) GBS infections, including: meningitis, pneumonia, and sepsis. Of the 1-2% of babies who develop infections, 2-3% full term (>37 weeks) babies and 20-30% preterm (<34 weeks) babies will experience fatalities (2).



What are my options?


Antibiotics: There are two antibiotic approaches currently recognized;  the Universal Approach (test all women at 35-37 weeks and treat all positive women with antibiotics) and the Risk Based Approach (treat laboring women with antibiotics if they have one or more risk factors). Care providers in the United States use the Universal Approach but there is some discussion as to whether that leads to administering antibiotics unnecessarily. The recommended  protocol is to administer IV antibiotics for 15-30 minutes every 4 hours during labor, until delivery. Current research has shown the benefit of using antibiotics is up to an 83% decrease in early onset infections when used during labor (3). However, the risks associated with antibiotic use include: disruption of mom’s microbiome, a temporary disruption of baby’s microbiome, increased incidence of mother/baby yeast infections, being hooked up to an IV during labor (limiting mobility), and the side effects associated with the particular antibiotics used (4).

 

Topical Antiseptic: Chlorhexadine (Hibiclens) is known to kill bacteria immediately and can affect vaginal GBS for up to 3-6 hours. The most promising protocol in the literature is to use Chlorhexadine vaginally every 4 hours during labor and then wipe the newborn down with Chlorhexadine immediately after birth. The benefits of this treatment is that it is cheap and avoids the use of antibiotics. The risks of using Chlorhexadine are that it may burn during use and there is not a lot of research to back up its use. The four small random controlled studies that have been done, do not show a decrease in GBS colonization of the infant (5).

 

Probiotics: Lactobacilli is a probiotic that has been shown to inhibit the growth of GBS. Lactobacilli has been used orally, topically, and vaginally to try to treat GBS in pregnant women. The benefits of this treatment include low cost and ease of treatment; there are some promising studies showing that lactobacilli can inhibit GBS growth as well as switch a positive GBS test to a negative one (6). The risk associated with this treatment option is the limited data we have on whether or not probiotics will prevent GBS infection in the newborn. The studies currently available show that probiotics can affect GBS bacteria but have not yet tested the effects specifically in pregnancy and delivery (7).

 

Garlic: Garlic is known to have natural antibiotic properties, so it is touted among many circles to be used for all different infections. Many websites provide treatment protocols that involve inserting garlic cloves in the vagina overnight in hopes of eliminating the GBS bacteria. The benefits of this treatment are low cost and ease of treatment. The risks associated with this option is that you will likely taste garlic while it is inserted in the vagina and there have been no human studies performed on the effectiveness of eliminating GBS in a pregnant woman. The one study that has researched this treatment option showed garlic can kill GBS in a petri dish after 3 hours (8).

 

No treatment: Doing nothing is always an option! If you choose this option, you obviously do not have any of the risks associated with antibiotics or the other treatments. You do, however, have a slightly higher risk of your baby getting meningitis, pneumonia, or sepsis (1-2% of all babies born to GBS positive mothers). Along with an even smaller risk of a fatality (2-3% of all full term babies who were infected with GBS).

 


As with every decision we are faced with during the motherhood transition, the decision to accept IV antibiotics or try an alternate treatment should be made through true informed consent. Having an open and honest conversation with your birth team about all of the risks and benefits is a beautiful place to start. If you have a local BIRTHFIT Regional Director in your area, we would love to assist you with education and support in this decision and many more as you traverse your motherhood transition!

 

 

Sara Rausch, DC, CYT, FASA

BIRTHFIT Davenport @birthfit_davenport_ia

 

  1. Johri, A. K., L. C. Paoletti, et al. (2006). “Group B Streptococcus: global incidence and vaccine development.” Nat Rev Microbiol 4(12): 932-942.
  2. CDC (2010). “Prevention of perinatal group b streptococcal disease.” MMWR 59: 1-32.
  3. Ohlsson, A. and V. S. Shah (2013). “Intrapartum antibiotics for known maternal Group B streptococcal colonization.” Cochrane Database Syst Rev 1: CD007467.
  4. Dekker, R. (2017, July 17). The Evidence on : Group B Strep. Retrieved from https://evidencebasedbirth.com/groupbstrep/
  5. Ohlsson, A., Shah, V.S., and Stade, B. C. (2014). “Vaginal chlorhexidine during labor to prevent early-onset neonatal group B streptococcal infection.” Cochrane Database Syst Rev: CD003520.
  6. Ho, M., Chang, Y., Chang, W. (2016). “Oral Lactobacillus rhamnosusGR-1 and Lactobacillus reuteriRC-14 to reduce Group BStreptococcus colonization in pregnant women: A randomized controlled trial.” Taiwan J Obstet Gynecol 55(4): 515-8.
  7. Zarate, G. & Nader-Macias, M. E. (2006). “Influence of probiotic vaginal lactobacilli on in vitro adhesion of urogenital pathogens to vaginal epithelial cells.” Lett appl Microbiol 43(2): 174-178.
  8. Cutler, R. R., Odent M, et al. (2009). In vitro activity of an aqueous allicin extract and a novel allicin topical gel formulation against Lancefield group B streptococci. J Antimicrob Chemother 63(1): 151-154.
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