Risk Factors Associated with Group B Streptococcus Colonization and Their Effect on Pregnancy Outcome
Journal of Gynecology and Obstetrics
Volume 3, Issue 6, November 2015, Pages: 121-128
Received: Nov. 12, 2015;
Accepted: Nov. 24, 2015;
Published: Dec. 30, 2015
Views 3444 Downloads 109
Lucia Matsiane Lekala, Department of Obstetrics and Gynaecology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
Rooyen Tinago Mavenyengwa, Department of Medical Microbiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Department of Health Sciences, Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia
Sylvester Rogers Moyo, Department of Health Sciences, Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia
Sogolo Lucky Lebelo, Department of Life and Consumer Sciences, College of Agriculture & Environmental Science, University of South Africa, Pretoria, South Africa
John Yenga Bolukaoto, Department of Life and Consumer Sciences, College of Agriculture & Environmental Science, University of South Africa, Pretoria, South Africa
Martina Onyedi Chukwu, Department of Life and Consumer Sciences, College of Agriculture & Environmental Science, University of South Africa, Pretoria, South Africa
Charles Maropeng Monyama, Department of Life and Consumer Sciences, College of Agriculture & Environmental Science, University of South Africa, Pretoria, South Africa
Maphoshane Nchabeleng, Department of Microbiological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
Tshimane Charles Tshepuwane, Department of Obstetrics and Gynaecology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
Sam Monokoane, Department of Obstetrics and Gynaecology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
Background: Group B Streptococcus (GBS) is an important cause of maternal and neonatal morbidity and mortality in many parts of the world. It has been implicated in adverse pregnancy outcomes. Maternal colonization has been found to be a major risk factor for invasive neonatal GBS disease. The main objective of this study was to identify the risk factors of Group B streptococcus colonization and its effect on pregnancy outcome. Methods: This was a prospective study in which pregnant women attending antenatal clinic (ANC) at Dr George Mukhari Hospital (DGMH) were recruited. These were at least18 years old and were at 16 weeks gestation. Vaginal and rectal swabs were taken at recruitment. Follow up of mothers until six weeks post-delivery and babies until three months of age was done. Results: A total of 340 pregnant women were then investigated for GBS colonization. Out of this number, 164 (48.2%) were GBS positive. The majority of the women (62.1%) were parity 1 and 2. Group B Streptococcus colonization was significant in women who had no matric education and who were unemployed. There was a significantly higher GBS colonization in women with previous history of miscarriages and stillbirths. The proportion of HIV positive, GBS colonized women was significant at 41.5% as compared to HIV negative GBS colonized (34.7%). Eight women (4.9%) presented with premature rupture of membranes (PROM) and the duration ranged from 0.5 to 72 hours. Ten (6.1%) women had preterm deliveries. Three (1.8%) women had wound sepsis post caesarean section and one (0.6%) had endometritis post vaginal delivery. A total of 7 (24.1%) babies were GBS positive. The number of live babies delivered was 167, with 1 case of miscarriage due to severe preeclampsia. There were 2 cases of early neonatal deaths which included 1 case of sepsis whereas the other one had multiple congenital abnormalities. Conclusion: Colonization by GBS in pregnant women at DGMH was high. Maternal risk factors identified were previous history of stillbirths/miscarriages, lack of education and being HIV positive. Overall pregnancy outcome both maternal and foetal was good.
Lucia Matsiane Lekala,
Rooyen Tinago Mavenyengwa,
Sylvester Rogers Moyo,
Sogolo Lucky Lebelo,
John Yenga Bolukaoto,
Martina Onyedi Chukwu,
Charles Maropeng Monyama,
Tshimane Charles Tshepuwane,
Risk Factors Associated with Group B Streptococcus Colonization and Their Effect on Pregnancy Outcome, Journal of Gynecology and Obstetrics.
Vol. 3, No. 6,
2015, pp. 121-128.
Narava S, G Rajaram G, Ramadevi A, Prakash GV, Mackenzie S: Prevention of perinatal group B streptococcal infections: A review with an Indian perspective. Indian J Med Microbiol 2014; (32)1: 6-12.
Woldu ZL, Teklehaimanot GT, Waji ST, Gebremariam MY: The prevalence of Group B Streptococus recto-vaginal colonization and antimicrobial susceptibility pattern in pregnant mothers at two hospitals of Addis Ababa, Ethiopia. Reprod Health 2014; 11: 80.
Arain FR, Al-Bezrah NA, Al-Aali KY: Prevalence of Maternal Genital Tract Colonization by Group B Streptococcus From Western Province, Taif, Saudi Arabia. J Clin Gynecol Obstet 2015; 4(3): 258-264.
Dangor Z, Lala SG, Cutland CL, Koen A, Jose L, Nakwa F, Ramdin T, Fredericks J, Wadula J, Madhi SA: Burden of invasive Group B Streptococcus disease and early neurological sequelae in South African infants. PloS ONE 2015; 10(4): e0123014.
Suzman AS, Baltimore RS, Fonseca SNS: Prevalence of maternal group B streptococcal colonization and related risk factors in Brazilian population. Braz J Infect Dis 2006; 10(4): 1433-46.
Edwards MS, Nizet V, Baker CJ. 2006. Group B Streptococcal infections, p 403–464. In Remington JS, Klein JO, Wilson CB, Baker CJ (ed), Infectious diseases of the fetus and newborn infant, 6th ed. Elsevier Saunders, Philadelphia, PA.
Moyo SR, Tswana SA, Nystrom L, Bergstrom S, Blomberg J, Ljungh A: Stillbirth and intrauterine infection, histological chorioamnionitis and microbiological findings. Int J Gynecol Obstet 1996; 54(2): 115-123.
Hoogkamp-Korstanje JAA, Gerards LJ, Cats BP: Maternal carriage and neonatal acquisition of group B streptococci. J Infect Dis 1982; 145(6): 800-803.
Dzowela T, Komolafe OO, Igbigbi A: Prevalence of group B Streptococcus colonization in antenatal women at the Queen Elisabeth Central Hospital, Blantyre – a preliminary study. Malawi Med J 2005, 17(3): 97-99.
Yow MD, Leeds L J, Thompson PK, Mason EO Jr, Clark DJ, Beachler CW: The natural history of group B streptococcal colonization in the pregnant woman and their offspring colonization studies. Amer J Obstet Gynecol 1980; 137(1): 34-38.
Brodeur BR, Boyer M, Charlebois I, Hamel J, Couture F, Rioux CR, Martin D: Identification of group B streptococcal Sip protein, which elicits cross protective immunity. Infect Imm 2000; 68(10): 5610-5618.
Busetti M, D’Agaro P, Campello C. Group B streptococcus prevalence in pregnant women from North-Eastern Italy: advantages of screening strategy based on direct plating plus broth enrichment. J Clin Pat 2007; 60: 1140-43.
Gray KJ, Kafulafula G, Matemba M, Kamdolozi M, Membe G, French N: Group B Streptococcus and HIV Infection in Pregnant Women, Malawi, 2008–2010. Emerg Infect Dis 2011; 17(10): 1932-1935.
de Steenwinkel FD, Tak HV, Muller AE, Nouwen JL, Oostvogel PM, S. M. Mocumbi SM: Low carriage rate of group B streptococcus in pregnant women in Maputo, Mozambique. Trop Med Int Health 2008; 13:427-9.
Mavenyengwa RT, Afset JE, Schei B, Berg S, Caspersen T, Bergseng H, Moyo SR: Group B Streptococcus (GBS) colonization during pregnancy and maternal-fetal transmission in Zimbabwe. Acta Obstet Gynecol Scand 2010; 89: 250-5.
Hansen SM, Uldbjerg N, Kilian M, Sørensen UB: Dynamics of Streptococcus agalactiae colonization in women during and after pregnancy and in their infants. J Clin Microbiol 2004; 42(1): 83–89.
Hernández TM, Soriano BD: High prevalence of group B Streptococcus colonization in Mexican pregnant women. Ginecol Obstet Mex. 2006, 74(3): 139-43.
Stoll BJ, Schuchat A: Maternal carriage of group B Streptococci in developing countries. Pediatr Infect Dis J 1998; 17(6): 499–503.
American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn: Revised guidelines for prevention of early onset group B streptococcal (GBS) infection. Pediatrics 1997, 99: 489–497.
Tsolia M, Psoma M, Gavrili S, Petrochilou V, Michalas S, Legakis N, Karpathios T: Group B streptococcus colonization of Greek pregnant women and neonates: prevalence, risk factors and serotypes. Clin Microbiol Infect 2003; 9: 832-838.
Larsen J, Sever J. Group B streptococcus and pregnancy: a review. Am J Obstet Gynecol 2008; 198(4): 440–448.
Shirazi M, Abbariki E, Ali Hafizi A, Shahbazi F, Bandari M, Dastgerdy E: The prevalence of Group B Streptococcus colonization in Iranian pregnant women and its subsequent outcome. Int J Fertil Steril 2014; 7(4): 267–270.
Gebremeskel TK, Zeleke TA, Mihret A, Tikue MD: Prevalence and Antibiotic Susceptibility Pattern of Streptococcus agalactiae Among Pregnant Women at Adigrat Zonal Hospital and Adigrat Health Center, Tigray, Ethiopia. J Gyn Obstet 2015; 3(2): 29-35.
Foxman B, Gillespie BW, Manning SD, Marrs CF: Risk factors for group B streptococcal colonization: potential for different transmis¬sion systems by capsular type. Ann Epidemiol 2007; 17: 854-862.
Manning SD, Tallman P, Baker CJ, Gillespie B, Marrs CF, Foxman B: Determinants of co-colonization with group B Streptococcus among heterosexual college couples. Epidemiol 2002; 13: 533–9.
Beitune P, Duarte G, Maffei CML, Quintana SM, Silva AC, Nogueira AA: Group B Streptococcus carriers among HIV-1 infected pregnant women: prevalence and risk factors. Eur J Obs Gynecol Reprod Biol 2006; 128: 54–58.
Baker CJ, Barrett FF, Yow MD: The influence of advancing gestation on group B streptococcal colonization in pregnant women. Am J Ob¬stet Gynecol 1975; 122: 820-823.
Hastings MJ, Easmon CS, Neill J, Bloxham B, Rivers RP: Group B streptococcal colonisation and the outcome of pregnancy. J Infect 1986; 12: 23-29.
Valkenburg-van den Berg AW, Sprij AJ, Oostvogel PM, Mutsaers JA, Renes WB, Rosendaal FR, Dorr PJ. Prevalence of colonisation with group B Streptococci in pregnant women of a multi-ethnic popula¬tion in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2006; 124: 178–183.
Aali BS, Abdollahi H, Nakhaee N, Davazdahemami Z, Mehdizadeh A: The association of preterm labor with vaginal colonization of group B streptococci. Iranian J Reprod Med 2007; 5(4): 191-194.
Anthony BF, Okada DM, Hobel CJ: Epidemiology of group B Strep¬tococcus: longitudinal observations during pregnancy. J Infect Dis 1978; 137: 524-530.
McKenna DS, Iams JD: Group B streptococcal infections. Semin Perinatol 1998, 22: 267–76.
Grimwood K, Stone PR, Gosling IA, Green R, Darlow BA, Lennon DR, Martin DR: Late antenatal carriage of group B Streptococcus by New Zealand women. Aust N Z J Obstet Gynaecol 2002; 42: 182-186.
Regan JA, Klebanoff MA, Nugent RP: The epidemiology of group B streptococcal colonization in pregnancy. Vaginal Infections and Pre¬maturity Study Group. Obstet Gynecol 1991; 77: 604-610.
Kim EJ Oh KY, Kim MY, Yong Soo Seo, Shin JH, Song YR, Yang JH, Foxman B, Ki M: Risk Factors for Group B Streptococcus Colonization Among Pregnant Women in Korea. Epidemiol Health. 2011; 33: e2011010.
Javanmanesh F, Eshraghi N. Prevalence of positive recto-vaginal culture for Group B streptococcus in pregnant women at 35-37 weeks of gestation. Med J Islam Repub Iran. 2013, 27(1): 7–11.
Kubota T: Relationship between maternal group B streptococcal colonization and pregnancy outcome. Obstet Gynecol 1998; 92: 926-930.
Beitune P, Duarte G, Maffei, CML, Kobori FC: Streptococcus agalactiae colonization among HIV-1-infected pregnant women: antimicrobial susceptibility evaluation. J Acq Imm Defic Synd 2007; 44(2):246.
Shah M, Aziz N, Leva N, Cohan D. Group B Streptococcus colonization by HIV status in pregnant women: prevalence and risk factors. J Womens Health (Larchmt) 2011; 20(11): 1737-41.
Mavenyengwa RT, Moyo SR, Nordbø SA: Streptococcus agalactiae colonization and correlation with HIV-1 and Hepatitis B seroprevalence in pregnant women in Zimbabwe. Eur. J. Obst. Gyn. Reprod. Biol 2010; 150: 34-8.
Uh Y, Jang IH, Yoon KJ, Lee CH, Kwon JY, Kim MC: Colonization rates and serotypes of group B streptococci isolated from pregnant women in a Korean tertiary hospital. Eur J Clin Microbiol Infect Dis 1997; 16: 753–6.
Madhi SA, Radebe K, Crew-Brown H, Frasch CE, Arakere G, Mokhachane M, Kimura A: High burden of invasive streptococcus agalactiae disease in South Africa. Annals of Tropical Paediatrics 2003, 23: 15-23.
Baker CJ, Barret FF: Transmission of group B streptococci among parturient women and their neonates. J Pediatr 1973; 83: 919-25.
Shet A, Ferrieri P. Neonatal and maternal group B streptococcal infections: A comprehensive review. Indian J Med Res 2004; 120: 141-50.
Ramos E, Gaudier FL, Hearing LR, Del Valle GO, Jenkins S, Briones D: Group B streptococcus colonization in pregnant diabetic women. Obstet Gynecol 1997; 89: 257-60.
Domingo P, Barquet N, Alvarez M, Coll P, Nava J, Garau J: Group B Streptococcal meningitis in adults: Report of twelve cases and review. Clin Infect Dis 1997; 25: 1180–7.
Sunkara B, Bheemreddy S, Lorber B, Lephart PR, Hayakawa K, Sobel JD, Kaye KS, Marchaim D: Group B Streptococcus infections in non-pregnant adults: the role of immunosuppression. Int J Infect Dis 2011; 16(2012) e182–e186.