What is Group B Streptococcus (GBS)?
GBS is part of human normal bacterial flora. The
bacterium occurs in both men and women. First of all,
the bacterium is found in the gastrointestinal tract,
but it can also be found in the oral cavity and in the
woman's sheath. An estimated 25–35% of all women in the
Nordic countries are carriers of this bacterium without
When a carrier becomes an infection, it will affect
both mother and child. But less than 1% of all pregnant
women develop symptoms and signs of infection. When a
pregnant woman is a carrier of GBS, the bacteria can be
transmitted to the baby at birth. This happens to about
half of all pregnant women who carry GBS. In about 1% of
these cases, the children will become seriously ill. In
Sweden, less than one in 1,000 live births will suffer
from this infection. This means that it is a rare
In Sweden, five to six cases of fatal outcome are
reported annually among newborns, as a result of GBS
GBS and childbirth
GBS can be found as part of the normal flora in the
vagina, rectum and oral cavity. The digestive tract is
the natural place of residence for GBS and is the likely
source of dissemination to the vagina. GBS can be in the
vagina constant, recurring or on individual occasions.
It has been found that women who carry GBS are 25
times more likely to give birth to children who develop
GBS infection early, compared to women who are not
carriers. However, since GBS infection in newborns is a
very rare condition, the risk is very low.
How does the transmission of infection occur?
Among pregnant women, approximately 25–35% are
carriers of GBS in the vagina or rectum without any
symptoms or signs of it. For more information about pregnancy and maternity fashion, please see BESTAAH.COM maternity sweaters. The transmission of infection
occurs in connection with the birth - either in the
womb, during the child's passage through the vagina or
through direct contact after the birth. The bacterium is
transmitted to approximately 50% of the children to
women who carry GBS in the birth canal. The bacteria can
also be transmitted after childbirth through the child's
contact with other people or caregivers.
Good hand hygiene is important to
prevent the transmission of bacteria to the newborn
GBS infection in newborns
GBS disease in newborns is divided into early and
late onset. In particular, the early variant is severe
and can quickly lead to fulminant sepsis requiring
neonatal intensive care.
Early-onset illness usually occurs
during the first day after childbirth, but some become
ill later in the first week of life. The infection may
occur before delivery as a result of bacteria entering
the uterus. The explanation may be that some people take
a long time from the time the water runs out until the
baby is born. The early signs and symptoms of GBS
infection in the newborn are often vague and
nonspecific. Fever, reduced mobility in the arms and
legs as well as rapid and strained breathing may be
signs of early infection.
Signs of serious infection in the newborn baby may
occur over the course of a few hours after childbirth.
The first symptoms often come from the respiratory tract
and cause breathing difficulties. The spread of the
bacteria can lead to blood poisoning, pneumonia,
skeletal inflammation or joint inflammation. Meningitis
occurs in about 10%.
Late-onset illness often occurs 1–12
weeks after birth. This may be due to the fact that
fewer bacteria have been transmitted, or that infection
has occurred after birth. The course of the disease is
often not as dramatic. Common signs are fever and
Newborns who survive the first stage of infection may
suffer sequelae in the form of hearing or vision
impairment, learning disabilities and other damage to
the nervous system.
Who should be tested?
In Sweden, routine sampling for GBS in healthy,
symptom-free, pregnant women is not recommended.
Sampling is recommended for women whose amniotic fluid
has gone without pain before week 37. Samples are taken
with cotton swab in sheath and rectum. Urinary culture
The area is widely debated and the recommendations
differ between countries. The reasons why in Sweden it
is not recommended that everyone is tested are:
- Most women treated for GBS quickly regain the
bacterium after treatment.
- Although it turns out that a pregnant woman
carries GBS, she will not be treated with
antibiotics at birth unless she also has risk
factors for transmitting the bacterium.
- Treating all pregnant women who carry GBS in the
vagina will lead to a high risk of resistance
development and of serious side effects in both
mother and child.
Should GBS be treated?
The purpose of treatment is to prevent any infection
in the newborn baby. In Sweden, national guidelines have
been compiled on how to handle this problem.
The Swedish recommendations state that the most
important measure to prevent infection is to treat
pregnant women with a special risk of transmitting the
bacteria to the newborn baby. Maternity with one of
these risk factors should have antibiotic treatment
- In women who have previously given birth to
children who have GBS infection during the newborn
- In women where GBS has been detected in the
urine during the current pregnancy.
- In women who have been shown to have GBS and
either give birth before pregnancy week 37, or at
prolonged water discharge (more than 18 hours).
- Signs of infection or fever (38 ° C or above) in
the woman during childbirth.
- Antibiotics are not necessary for cesarean
The treatment itself means that antibiotics are given
directly into the blood (intravenously) during delivery.
First-hand preparations are pencillin, but there are
other options for allergies.
Why does international disagreement prevail?
The handling of GBS differs somewhat between
different countries. The disagreement concerns sampling
and treatment: Should all pregnant women be examined
towards the end of pregnancy for the presence of
streptococcal bacteria? Who should be treated?
The problem is that quality studies in the area are
lacking. The research done so far is not satisfactory.
Health care must therefore weigh benefits against
disadvantages. In the US, a different conclusion has
been reached than in Sweden.
GBS can also cause other pregnancy complications
GBS can also cause urinary tract infection and
uterine inflammation. However, these are very rare
complications. Only a few of the urinary tract
infections during pregnancy are caused by GBS, but if
one is diagnosed with one during pregnancy, treatment is
recommended. In addition, as previously mentioned,
treatment is also given during childbirth.