Group B Streptococcus, also known as Group B Strep or GBS for short, is one of the trillions of organisms that normally inhabit the human intestinal tract. The bacteria that causes GBS normally lives in the intestines, vagina, or rectum, and approximately 25% of all healthy women carry group B strep bacteria. For most women, there are no symptoms of carrying the GBS bacteria.
While it can cause infection in people of any age, GBS doesn’t seem to play a particularly beneficial role in human health, nor, when kept in check by healthy gut, vaginal, or bladder flora, does it usually cause harm to adults who are colonized with it. In fact, most people colonized with it will never develop infection.
GBS in pregnancy can cause bladder and uterine infections, miscarriage, and increases the risk of premature labor, premature rupture of membranes, and stillbirth.
When a baby is exposed to GBS in labor or during the birth, they have a 50% chance of becoming colonized with GBS. Most healthy, full-term babies will just develop their own colonization of the skin and gut as a result, without developing infection.
A small percentage who get exposed will become infected. The risk of a baby developing a serious, life-threatening GBS infection, according to the CDC, is 1 to 2%. GBS infection in the newborn can lead to long stays in the NICU, and up to 44% of infants who survive GBS meningitis (infection in the brain and spinal cord) end up with long-term health problems, including developmental disabilities, paralysis, seizure disorders, hearing loss, and vision loss.
As of 2020, the American College of Obstetricians and Gynecologists (ACOG) has determined that the best time to test for GBS presence is between the 36th and 37th weeks of pregnancy. Testing at this time is believed to provide coverage for women who don’t go into labor until in their 41st week.
If you test positive for GBS, antibiotic treatment during labor is recommended by the CDC.
Which can put mama in a tough spot – determining which carries the greater risk:
take the chance on your baby developing a GBS infection if you don’t do the antibiotics
take an antibiotic during labor that can negatively impact your baby’s microbiome*.
* Remember that the health of your baby’s microbiome can influence all factors of their health, including long term health.
Here’s the good news!
There are natural remedies to reduce colonization, which will ???? hopefully ???? result in a negative GBS test.
Before we get to that though, let’s dig a little deeper into GBS testing, treatment options, and the side effects of antibiotics on babe!
As mentioned above, the best time to test for GBS presence is between the 36th and 37th weeks of pregnancy. Testing is generally done by your obstetrician, family doctor, or midwife, and the test consists of obtaining a bacterial culture of a sample collected from a simultaneous vaginal and rectal swab.
Studies have shown that GBS positive cultures have a high degree of accuracy in predicting GBS colonization status at birth if cultures are collected within 5 weeks of birth and test results are positive.
A negative test, however, does not mean you do not have the infection – it could be a “false negative” meaning that the test missed the infection.
You can also become colonized after the test was done, so while your test could have been negative in pregnancy, you could be positive at the time of labor.
I know what you’re about to ask me:
“But Sarah, can’t I just skip the test to avoid having antibiotics during labor?”
Yes, you absolutely can.
If you don’t know whether you’re GBS-positive and you’re having your baby in the hospital, or have to transport from a home birth to the hospital with any risk factors for GBS, you’re still going to be prescribed the antibiotic.
On the other hand, if you’ve been tested and have had a negative test result, then the antibiotic isn’t indicated and you’re in the clear from the decision. Having a negative test result can actually be an advantage and can put your mind at ease if you’re worried about being GBS-positive.
And, what’s more, if you are GBS-positive and you know before going into labor, you can use the time to learn about GBS and make an educated decision on whether you should use the antibiotic or not.
It’s the same principle behind trying to “hack” the test by using natural treatments for the few weeks before the test to achieve a negative test result – you might have reduced the colonization so that it was low enough to give you a negative, but you might still be colonized at the time of birth and not know it.
When it comes to GBS infection in pregnancy, once you test positive – even if you have a negative test later in the same pregnancy – you are considered to be GBS-positive and antibiotic treatment is recommended by the CDC.
So, while you might use natural approaches to try to reduce your colonization, if you are having your baby in a hospital or birthing center, the standard protocol would still be to administer antibiotics during labor.
All of this to say –
KNOWLEDGE IS POWER.
Universal prophylaxis with IV antibiotics during labor is recommended if you meet any of the following criteria:
It is recommended that women receive antibiotics at least four hours before the baby is born for maximum effectiveness in preventing infection in babe. Since the time of birth can’t be predicted, it’s recommended that antibiotics be started when you arrive at the hospital, and given every four hours until the baby is born.
If you have a positive prenatal GBS culture, but have a cesarean before you go into labor, with intact membranes at the start of the cesarean, you do not require antibiotics to treat GBS.
It’s common knowledge that antibiotics can have a negative affect on your gut microbiome, so it’s normal that your newborn’s microbiome will be on your mind with a positive GBS diagnosis.
Fortunately, there’s evidence to suggest that any microbiome disruptions, due to the administration of antibiotics at birth, are generally resolved within two months.
And, what’s more, is that data suggests that the use of antibiotics for less than 24 hours during labor is not a source of long-term microbiome damage AND the same data suggests that any short-term damage can be mitigated by breastfeeding.
So, in a nutshell:
Antibiotics used during labor by mama can negatively impact the baby’s microbiome; however, it appears that if antibiotics are used for less than 24 hours, the risk is short-term.
If baby is breastfed – for ideally about 6 months – the risk is mitigated. It’s also possible – and recommended – to give babe an infant probiotic for a minimum of 6 months to further prevent some of the potential impacts of microbiome disruption – like eczema, allergies, and asthma – that have been associated with antibiotic use in pregnancy.
Now let’s get to the good stuff about how we can naturally reduce GBS colonization ????.
I talk about the importance of a healthy and happy gut – and vaginal – microbiome all the time … and for good reason!
New research is regularly being published on the role of a healthy vaginal and gut microbiome in preventing vaginal infections in general, and that the presence – or absence – of certain vaginal microorganisms may prevent or contribute to the likelihood of GBS colonization.
A healthy microbiome has also been found to mitigate risk of miscarriage, preterm labor + vaginal and bladder infections during labor!
Here’s how we support a healthy microbiome:
* higher risk symptoms: GBS colonization in a prior pregnancy, frequent UTIs or vaginal infections, history of preterm labor, or early rupture of membranes
Probiotics have been shown to be beneficial to the vaginal flora, and are capable of inhibiting the growth of vaginal pathogens and reducing the frequency of bladder and vaginal infections (like yeast infections and bacterial vaginosis).
The reduction in yeast infections is important – a 2020 study found that the presence of Candida albicans (yeast) vaginally promotes bladder colonization of Group B Streptococcus!
So given the beneficial and protective effects of probiotics against UTI, preterm labor, and protection of the baby’s microbiome when taken by the pregnant mother, I recommend mamas-to-be include a probiotic starting ideally in the preconception phase, but for sure in the first trimester taken throughout your entire pregnancy to aid in the prevention of GBS colonization … hopefully reducing the need for antibiotics during and after labor and delivery.
A typical dose is 1 to 2 capsules of a probiotic containing at least 10 billion CFUs, to be taken orally, daily during pregnancy, and especially in the 3rd trimester, not just to help prevent GBS, but also because it has been shown to reduce the risk of atopic conditions in kids (allergies, eczema, asthma) when taken by mom in the last third of the pregnancy.
In addition, a capsule can be inserted vaginally, nightly before bed, starting at the onset of the 3rd trimester and continuing until just prior to GBS testing.
Here’s the thing – if you do need antibiotics during labor, IT’S OK. The most important thing is to be educated on your choices, and the impacts that your decisions could have. You have to do what’s right for you and babe, and it’s important to follow your gut.
See what I did there? ????
1. Group B Streptococcus is not a STD, and it’s one of the trillions of organisms that normally inhabit the human intestinal tract.
2. If you have a positive GBS test at 36-37 weeks gestation, the recommendation is the use of IV antibiotics during labor.
3. It is possible to naturally decrease GBS colonization during pregnancy to reduce the risk of needing antibiotics during labor!
I want to hear from you – leave me a comment below and we can continue the conversation!
Were you GBS-positive during labor?
If yes, did you feel like you knew enough to make an educated decision on whether or not to use antibiotics during labor?
Looking to have a one-on-one conversation about GBS during pregnancy? Find a time that works for you, and let’s get a date on the calendar!