Colonization with group B streptococci in pregnancy and adverse outcome,☆☆,,★★

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Abstract

OBJECTIVE: Our purpose was to study the association of cervicovaginal colonization with group B streptococci with pregnancy and neonatal outcome. STUDY DESIGN: A prospective study was conducted at seven medical centers between 1984 and 1989. Genital tract cultures were obtained at 23 to 26 weeks' gestation and at delivery. Prematurity and neonatal sepsis rates were compared between group B streptococci positive and negative women. RESULTS: Group B streptococci was recovered from 2877 (21%) of 13,646 women at enrollment. Heavy colonization was associated with a significant risk of delivering a preterm infant who had a low birth weight (odds ratio = 1.5, 95% confidence interval 1.1 to 1.9). Heavily colonized women given antibiotics effective against group B streptococci had little increased risk of a preterm, low-birth-weight birth. Women with light colonization were at the same risk of adverse outcome as the uncolonized women. Neonatal group B streptococci sepsis occurred in 2.6 of 1000 live births in women with and 1.6 of 1000 live births in women without group B streptococci at 23 to 26 weeks' gestation ( p = 0.11). However, sepsis occurred in 16 of 1000 live births to women with and 0.4 of 1000 live births to women without group B streptococci at delivery ( p < 0.001). CONCLUSIONS: Heavy group B streptococci colonization at 23 to 26 weeks' gestation was associated with an increased risk of delivering a preterm, low-birth-weight infant. Cervicovaginal colonization with group B streptococci at 23 to 26 weeks' gestation was not a reliable predictor of neonatal group B streptococci sepsis. Colonization at delivery was associated with sepsis. (AM J OBSTET GYNECOL 1996;174:1354-60.)

Section snippets

MATERIAL AND METHODS

The Vaginal Infections and Prematurity Study enrolled women attending antenatal clinics at seven participating centers between Nov. 1, 1984, and March 31, 1989. The centers and total number of patients enrolled were Columbia University (n = 3951) and Harlem Hospital (n = 849), New York City; University of Washington (n = 612), Seattle; University of Oklahoma (n = 3900), Oklahoma City; University of Texas (n = 1265), San Antonio; Louisiana State University (n = 2513) and Tulane University (n =

RESULTS

There were 13,914 women in the Vaginal Infections and Prematurity Study. Group B streptococci were recovered at 23 to 26 weeks from 2877 (21.1%) of the 13,646 women who had group B streptococci cultures available. Light colonization (recovery from selective media only) occurred in 1640 women (12%), and heavy colonization (recovery from nonselective media) occurred in 1237 women (9.1%). Factors associated with group B streptococci colonization among 7742 of these women have been published

COMMENT

In this study the association between group B streptococci and abnormal pregnancy outcomes was influenced by the density of colonization. Women with heavy group B streptococci colonization at 23 to 26 weeks' gestation had an increased risk of delivery of a preterm LBW infant after we adjusted for other risk factors. Women with light group B streptococci colonization had the same risk of preterm delivery, LBW, and other adverse pregnancy outcomes as the women who had negative cultures.

The modest

Acknowledgements

Other members of the Vaginal Infections and Prematurity Study group are as follows: Drs. Sumner J. Yaffe, Charlotte S. Catz, George G. Rhoads (now at the University of Medicine and Dentistry of New Jersey), Donald McNellis, and Heinz W. Berendes, National Institute of Child Health and Human Development; Richard A. Kaslow (now at University of Alabama, Birmingham), Mary Francis Cotch (now at Research Triangle Institute), and George F. Reed, National Institute of Allergy and Infectious Diseases;

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      In the United States, GBS colonization rates during pregnancy range from 15% to 60%, depending on the study population.3–5 Vaginal colonization with GBS occurs in approximately 18% of pregnant women worldwide6 and has been linked with preterm birth (PTB),2,7–9 preterm premature rupture of membranes (PROM),10 and neonatal intensive care unit (NICU) admission.11 GBS vaginal colonization is a risk factor for neonatal transmission during delivery12,13 and to infants during the postnatal period14 and is associated with a 3-fold increased rate of NICU admission.11

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    From the Department of Pediatrics, Columbia University,athe National Institute of Child Health and Human Development, National Institutes of Health,bthe Department of Obstetrics and Gynecology, University of Washington,cthe National Institute of Allergy and Infectious Diseases, National Institutes of Health,dthe Research Triangle Institute,ethe Department of Obstetrics and Gynecology, University of Texas,fthe Department of Pediatrics, University of Oklahoma,gand the Department of Medicine, Louisiana State University.h

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    Supported by contracts HD-3-2832 through HD-3-2836 and AI-4-2532 from the National Institutes of Health.

    Reprint requests: Mark A. Klebanoff, MD, DESPR, NICHD, NIH, 6100 Bldg., Room 7B03; Bethesda, MD 20892.

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