05/13/2020
An article written by Midwifery today magazine which highlights why it is not necessarily a good idea to administer antibiotics to all GBS positive Mamas:
Premature babies have a higher attack rate and a higher mortality rate than those born full term. The attack rate is higher with prolonged rupture of fetal membranes and the risk increases if infection of the amniotic fluid occurs (Woods 2014).
The argument of the CDC is persuasive that giving all pregnant women who test positive for GBS intrapartum antibiotics makes scientific sense and will save lives. Not everyone is convinced. The UK does not recommend the culture during pregnancy and treat with intrapartum antibiotics when the baby is premature or when there is prolonged rupture of membranes before birth or if there are other risk factors for infection. The Cochrane Review states that giving antibiotics is not supported by conclusive evidence.
The neonatal mortality rate per 1000 live births in 2013 was 3 in the UK; In the US, it was 4/1000.The policy of routinely giving preventive antibiotics in labor to up to 1/3 of all women, for a disease that will affect 1–2 babies out of 1000 culture-positive women with a treatable disease, which is rarely serious in low-risk, full-term babies, still might seem defensible until you begin to consider the information from the Microbiome Project.
This project, which took place from 2007 through 2012, involved 80 research centers (university and other) and over 200 major researchers in sequencing the genome of the bacteria, which live in and on the human body. A lot of the information learned still needs further study, but one thing is clear: Our personal microbiome, the bacterial community of our bodies, is important to our health, especially in the development of our immune systems. The microbiome starts with the mother, in the womb and in the birth process, and in early life with breastfeeding and a healthy lifestyle. The transmission of an intact microbiome from mother to baby may be inhibited by intrapartum antibiotics.
Dr. Martin Bl**er, director of the Human Microbiome Program at New York University and former chair of medicine there, stated in an interview on National Public Radio that if a baby is born without a full and varied microbiome, either because of antibiotics or because of a cesarean birth, the development of the baby’s immune system can be affected, causing a vulnerability to many serious illnesses. Obesity, asthma, Crohn’s disease, eczema and juvenile diabetes are among them.
It would seem that with both potential harm and potential benefit to giving intrapartum antibiotics to women who test positive for group B strep, the choice should lie with the mother in consultation with her medical care providers and with her chosen care givers. The duty of the care providers could be to provide an informed choice counsel to the family, to give them their advice and to support them in their decision.
Reference:
Woods, CJ. 2014. “Streptococcus Group B Infections.” Medscape. Accessed February 20, 2015.
— Marion Toepke McLean
Excerpted from “The Beta Strep Dilemma,” Midwifery Today, Issue 113
