What is Group B Strep?
Written by Leanne Devine, Associate & Birth Injury Solicitor
As a birth injury solicitor, I feel such sadness when I take on any new case – but when the case relates to a Strep B infection, it is particularly distressing. This is because the infection is often entirely treatable. Instead, I have multiple clients who have suffered a severe brain injury which will impact them for the rest of their lives – as a result of medical staff failing to recognise and treat the infection during pregnancy or labour.
What is Group B Strep?
Group B streptococcal infection, also known as Strep B or GBS, is an infection caused by bacteria which lives in the vagina or rectum. The infection itself is quite common in both men and women. If a woman is pregnant, the infection can pass from the mother to the baby during labour. Untreated, it can sometimes cause serious harm to the baby.
In the UK, around 800 babies a year develop a GBS infection. Around 50 babies will die and 75 will survive, but with life-changing injuries. Despite these statistics, many women are not aware of GBS whilst pregnant, and there is certainly not a great awareness of the damage it can cause.
Currently, if a woman wants to have a test to confirm a Strep B infection, this is something which has to be paid for privately – as the test is not available on the NHS. The test, an ECM test, can be used to detect GBS late in pregnancy, and costs around £40 privately. The test should ideally be carried out at 35-37 weeks’ gestation. If positive, the infection is treatable with antibiotics during labour.
What happens if a mother is diagnosed with Group B Strep during pregnancy?
If diagnosed with a GBS infection, the mother will be prescribed antibiotics during labour to prevent the risk of the infection transferring to the baby. When the baby is born, they will have additional checks to ensure they are healthy in the early neonatal period. Group B strep can cause other serious infections too, such as sepsis, meningitis and pneumonia. It is the most common cause of severe infection in newborn babies. And it is therefore essential that doctors ensure the baby does not have any symptoms of infection, which could result in developing one of these conditions. The failure to recognise and treat any of the conditions outlined here, can have devastating consequences for a baby and their family.
It should also be noted that in accordance with NICE Guidance and many local policies, women who have been diagnosed with a GBS infection in a previous pregnancy or who have had a previous baby with an invasive GBS infection, should be prescribed antibiotics during labour for the subsequent pregnancy.
Should there be universal antenatal screening for Group B Strep in pregnancy?
In 2017 the Royal College of Obstetricians and Gynaecologists (RCOG) published a guideline entitled ’Prevention of Early-onset Group B Streptococcal Disease.’ The summary to the Guideline states that GBS is recognised as the most frequent cause of severe early-onset infection in newborn infants. A third edition of the Guideline is now available.
The Guideline recommends that all women should be provided with an information leaflet about GBS in pregnancy. It also confirms that universal bacteriological screening is not recommended, and maternal request is not an indication for bacteriological screening.
Many charities have been campaigning for an antenatal screening programme to identify and treat GBS prior to labour. This could help to prevent the loss of so many babies and avoid the life-changing injuries to those babies who contract the infection and survive. For those families who have lost babies, or who have a child with life-changing injuries, the knowledge that one test could have prevented the loss or harm, is often difficult to bear.
What signs of Group B Strep should parents look out for in a young baby?
The guideline provides a list of what to look out for in a newborn baby and to seek urgent medical advice if the baby:
- Is showing abnormal behaviour (for example inconsolable crying or listlessness), or
- Is unusually floppy, or
- Has developed difficulties with feeding or tolerating feeds, or
- Has an abnormal temperature unexplained by environmental factors, or
- Has rapid breathing, or
- Has a change in skin colour.
What does the future hold?
Sadly, there needs to be a raised awareness of what GBS is and the damage it can cause if untreated, not just in pregnancy but in a newborn baby too. There needs to be consistency in this approach, with all Trusts and health boards ensuring that all women are provided with the information they need during pregnancy; to ensure that they are aware of this infection and the harm it can cause to their baby.
There should also be an awareness that if a mother wishes to, she can obtain a private test to check whether she is a carrier of the infection. Many of the women I have spoken to are unaware that this is even an option for them.
Phase two trials of a GBS vaccine have taken place in South Africa, which have demonstrated safety as well as efficient transplacental transfer of vaccine-specific antibodies.
Whether the NHS will introduce a universal antenatal screening remains to be seen, but in my personal experience of dealing with families affected by GBS, this would prevent a lot of harm and heartache.