Updated UK GBS guideline - Dr Sara Wickham

The Royal College of Obstetricians and Gynaecologists has published updated UK GBS guidance. The document is about preventing early onset group B strep (GBS) disease. The guidance calls for all pregnant women to be provided with appropriate information about GBS to support decision making and to raise awareness of the signs and symptoms of the infection in babies.

There is also a change to the recommendation where women are in preterm labour. Previously, antibiotics were not recommended for GBS prevention alone for this group of women (although some women in preterm labour ended up with antibiotics for other reasons). The guideline formerly explained that, although the chance of early-onset GBS disease is higher in babies who are born early than in babies who are born at term, there were good reasons not to routinely recommend antibiotics in these women.

Those reasons included that

around half of all women who present at hospital in what is thought to be in preterm labour will not actually give birth to their babies preterm;
giving antibiotics to all women in preterm labour would mean a large number of women and babies would be exposed to antibiotics and ‘as the risk of EOGBS infection in this group of infants is still low, prompt management of early-onset sepsis, if it occurs, is preferable to IAP for large numbers of women.” (2012: 5)
“women presenting in uncomplicated spontaneous preterm labour with intact membranes are the same group of women as those recruited to the ORACLE trial, where there was evidence of harm in terms of adverse neurodevelopmental outcome including cerebral palsy in their infants at 7 years of age in the absence of any demonstrable benefit in the short term” (2012: 4).

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The new guidance notes that, “Women are at higher risk of passing GBS onto their baby if they go into preterm labour with nearly a quarter of all cases of early onset GBS in 2015 (22%) in babies born prematurely. Compared to a risk of one in 2000 for babies born at term, approximately one in 500 preterm babies will develop EOGBS disease. The mortality rate from infection increases from 2-3% for at term babies to 20-30% for those born before 37 weeks.”

Antibiotics carry risks and consequences for both women and babies too, and this is thus a difficult decision which many women will want to weigh up and make for themselves.

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