Last month the World Health Organisation (WHO) published a new guideline, the main purpose of which was to recommend that pregnant women should be screened for Group B streptococcus (GBS) so that they can be given antibiotics to help prevent early onset group B Strep infection.

It is already known that early onset GBS infection can be prevented with anti-biotics and since 2015 the WHO has recommended anti-biotics in pregnancy for women carrying GBS. However, different countries take different approaches to identifying those women who have GBS and so need anti-biotics when they go into labour. 

The new guideline suggests either carrying out universal screening (i.e. the routine testing in pregnancy of all pregnant women) or taking a risk-based approach to determine who should receive anti-biotics. However, the WHO guideline notes that universal screening is probably associated with reduced early onset GBS disease in newborns as opposed to a risk based approach and we at JMW think this is important to highlight.

Here in the UK a risk based approach is currently taken, where not all pregnant women are tested but treatment is given depending on what is thought to be their risk of GBS, based on whether the woman carried GBS in a previous pregnancy, goes into labour prematurely, has a fever or has prolonged rupture of her membranes, for example. 

However, the risk-based approach relies on women knowing their full medical history and maternity staff recognising the risk of GBS in pregnancy when they occur. Our experience of working with families whose babies have contracted group B Strep suggests to us that is not always happening at the moment. Some women do not know if they had GBS in a previous pregnancy. Like our client Louise* they may know they had an infection but not the cause. In other cases, although our clients have had one of the risk factors for GBS during pregnancy that was not picked up on and anti-biotics were not given when they should have been. That is what happened to Vanessa*, who was sent home from hospital with a high fever, and Sarah*, whose prolonged rupture of the membranes went un-noted on a busy maternity ward.

Nicola Wainwright at JMW said: 

“The indication from the WHO that universal screening is probably the more effective way of preventing cases of GBS is crucial to note. So many of the families I work with have been  let down by the risk based approach and have been left wishing they had been offered a routine test, which could have prevented their babies contracting GBS. I hope that those at whom the guideline is aimed, including health professionals responsible for developing national and local health-care guidelines and protocols, will strongly consider universal screening, which in my view will help reduce the missed cases of GBS that we are seeing far too often and which are devastating too many families.’

JMW are working with the UK based charity Group B Strep Support (GBSS) to raise awareness of GBS and to try to prevent GBS infecting babies. You can read more about the work of GBSS here: https://gbss.org.uk/