Routine GBS Screening in pregnancy not recommended.

GBS screening can cause more harm than good with large numbers of women unnecessarily receiving antibiotics.


Routine GBS screening is not recommended in the UK

Screening pregnant women for Group B streptococcus (GBS) is “not recommended” by the National Screening Committee (NSC) in the UK but remains common in Australia.

Read the full article here

What is GBS?

Group B streptococci (GBS) are bacteria that occur naturally in the vagina and bowel in some women. Carrying GBS on the body is normal and rarely harmful to healthy, non-pregnant women.

However, the bacteria can pass to a baby in the birth canal during labour and there is a small chance a baby who contacts GBS during labour will develop an infection and become seriously ill.

Giving antibiotics to the mother during labour aims to reduce the risk of a baby developing a GBS infection soon after birth.

When will Australia Catch Up?

Routine GBS screening is a widely accepted and implemented practice in Australia.

RANZCOG LOGO and GBSThe Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) proposes 2 alternative approaches. Universal screening of all women or a risk based approach.

Universal culture-based screening, using combined low vaginal plus or minus anorectal swab at 35-37 weeks gestation, or a clinical-risk factor based approach are both acceptable strategies for reducing EOGBS.

That sounds reasonable doesn’t it? I can just have a GBS screen if I am high risk.

Weeeeell. The short answer is yes. Arguing your point depends which approach your healthcare provider takes and there is not a standard approach in Australia.

If your health care provider takes the universal approach (screen all pregnant women) and you do not want the test, you will need to challenge their routine and decline the test which can be easy or a difficult journey depending on the mood and attitude of your care provider.

Screening based on risk factors only

There are three significant factors that place babies at increased risk of infection: fever during labour, water breaking 18 hours or more before birth (prolonged rupture of membranes, or PROM), and/or labour or broken water before 37 weeks.

Of course it is every pregnant women’s right to chose to accept or decline any test they like. The problem is that women with unknown GBS status who show certain risk factors will be prescribed antibiotics in labour. And those who GBS status is unknown are often prescribed antibiotics as a preventative measure. You know, just in case.

As you may know there are ongoing efforts to reduce antibiotic use in healthcare and for good reason.

Problems with antibiotics
  • Allergic reaction to penicillin. This is rare, but severe reactions are estimated to be 1 in 10,000 and 1 in 100,000 for a fatal reaction
  • Mothers and babies are more likely to have yeast infections following the treatment.
  • Use of antibiotics can increase the chance of other life-threatening infections such as sepsis and E. Coli, due to antibiotic resistance.
  • Antibiotics don’t prevent infection in almost 30% of cases.
  • The short and long-term effects on the baby’s gut microbiome are unknown

The problem with GBS is that it a sneaky little bug, that comes and goes in the human body. 25% of woman at any point in time will test positive. It is also transient meaning you can have it one week and test negative the next and visa versa. Being GBS positive is not a predictor of which babies may become unwell.

So here are some scenarios:

At 36 weeks test negative but when in labour you could be positive for GBS and not know it, creating a false sense of security.

Test positive at 36 weeks, naturally clear the GBS by birth but cop an unnecessary dose of antibiotics.

Test positive and receive antibiotics which may or may not be effective anyway.

Decline the test and decline antibiotics if you become high risk baby may or may not contract a GBS infection.

Decline the test, never develop any high risk factors birth your baby and baby may or may not develop some sort of infection.

Confused? 

You are not the only one. As I said Australia maternity healthcare providers still can’t agree themselves. The trend worldwide is away from universal screening and I look forward to Australia developing a consensus.

To me pregnancy is a great preparation for parenting . The decision to have or not have the GBS screen is just one of a multitude of decisions we must make for our baby.

Although GBS infection in newborns is serious, there are risks as well as benefits to treatment. It is important to have information relevant to your risk factors, in order to make an informed choice.

It is our responsibility to do our research and decide what is best for us and our babies.

Prevention of GBS
  • Boost natural immunity (That’s a whole other post)
  • Refuse vaginal exams
  • Avoid internal foetal monitoring
  • Refuse membrane stripping or sweeping
  • Avoid induction of labour or application of cervical ripeners
  • Do not permit artificial rupture of membranes
  • Breastfeed immediately and frequently. Colostrum is full of antibodies that strengthen the baby’s immune system.
References and links

BellyBelly

Huffington Post Article

RANZCOG Guidelines


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