Group B Strep and Pregnancy

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This artistic recreation, based on scanning electron microscopy (SEM), depicts a three-dimensional (3D), computer-generated image, of a group of Gram-positive, Streptococcus agalactiae (group B Streptococcus) bacteria. Photo Credit: Alissa Eckert, who is a medical illustrator at the CDC.

By Shawn Ruiz

Group B Strep (GBS), also known as Streptococcus agalactiae, is a Gram-positive, beta-hemolytic, catalase-negative, facultative anaerobe that is a normal component of the gastrointestinal and genitourinary tracts[1]. In fact, GBS colonizes the gastrointestinal and genitourinary tracts of up to 50% of healthy adults[2]. Most healthy adults who are colonized by GBS will not experience any symptoms or GBS-related infections. While the bacteria is usually harmless in healthy adults, it is a major cause of meningitis, pneumonia, and and sepsis in neonates[3]. Moreover, GBS is the leading infectious cause of neonatal mortality and morbidity in the United States; between four and six percent of babies who develop GBS disease die[4][5]. GBS causes both early onset (<7 days old) and late onset (7-90 days old) infections in neonates[4]. The main risk factor for an early-onset GBS infection in a neonate is colonization of a birthing person's genital tract with Group B strep during labor[4]. About one in four pregnant individuals carry GBS in their body[5]. If the bacteria is present in a pregnant person, it can be directly transferred to their baby in a multitude of ways. For example, GBS can travel from the vagina into the amniotic fluid where the baby can ingest it and/or the baby can come into contact with the bacteria as they make their way down the birth canal[3]. In the early 1990s, the early GBS infection rate was 1.7 cases per 1,000 births[3]. In an effort to decrease this infection rate, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics recommended screening pregnant individuals for GBS[3]. As a result, it is now common practice to screen pregnant individuals for GBS at some point between 35 and 37 weeks of pregnancy[5]. Pregnant people who test positive for GBS are treated with intravenous antibiotics during labor[5]. Penicillin and ampicillin are the recommended antibiotics for intrapartum GBS prophylaxis[6]. Early GBS infection rates in the United States have significantly dropped (0.25 cases per 1,000 births) since these preventative measure went into effect around 1995[3].

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Authored for BIOL 238 Microbiology, taught by Joan Slonczewski, 2021, Kenyon College.