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Group B Strep testing in pregnancy – surely time for change?

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    Kerstin Kubiak considers the controversial decision of the Department of Health who have advised they will not be implementing a national screening programme for testing for Group B Strep infection in the UK.

    By Kerstin Kubiak

In the UK there is no routine testing offered for Group B Streptococcus (GBS) during pregnancy; such testing is only available where there is a high index for suspicion of maternal infection or if the mother chooses to opt for private testing which she arranges herself.

The result is that many babies acquire GBS infection during pregnancy or the childbirth process; although this infection may be benign for the majority of infants, for others it can take hold with devastating consequences. It’s for this reason the charity Group B Strep Support have endlessly campaigned for change so that all women receive routine ante natal testing in an effort to give the opportunity to treat the infection before it can take hold.

The Department of Health has refused to fund routine testing of women in pregnancy as they claim there are insufficient benefits to justify the cost of doing  so.  A recent review of the National Screening Committee maintained the view that there was “insufficient evidence” to justify the need for such a screening programme. However a recent study undertaken at Northwick Park Hospital in London has demonstrated that routine testing (of 6,000 women in the study cohort) reduced their neonatal infection rate by a staggering 83%. Given this impressive result we ask whether surely, in order to garner sufficient evidence, more funding must be put in place for a larger scale study, which is to experimental standards rather than an observational study only.

The study:

The study entitled “Outcome of a screening programme for the prevention of neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit: an observational study” was undertaken by the microbiologist Dr Roa Gopal and colleagues at Northwick Park Hospital and published in the BMJ (1). The need for the study was felt by the obstetric, midwife and microbiology teams at the hospital as their rate of neo natal GBS infection was almost 4 times the national average (despite risk based testing for GBS infection) and was becoming increasingly of concern. They therefore wanted to universally screen all participants for GBS carriage and for women who tested positive to offer antibiotics during labour to avoid the baby becoming infected.

In the study women who agreed to participate in the research were tested for GBS carriage between 35-37 weeks into their pregnancy; 69% of all women eligible to take part in the study choose to do so but that 98% would accept the offer of screening. The study concluded that an ante natal screening programme can be set up and implemented within maternity care and is associated with a fall in infection rates of the neonates. Further multi centre scientific studies must surely now be rolled out to demonstrate whether such reductions are demonstrable across the board. It is not clear whether this Trust will now continue to fund such testing on a routine basis.

The study showed that 1459 women needed to be screened to prevent one case of early onset GBS infection in a neonate.

The response of Group Strep B Support:

Jane Plumb, the Chief Executive of Group B Strep Support welcomed the results of this study and called again for the National Screening Committee to reconsider it’s findings before coming to any conclusions about the validity of routine testing.

She further commented:

“…ante natal screening for group B Strep carriage works in a busy, complex, multicultural UK setting and reinforces international evidence that group B Strep screening associated with intrapartum antibiotic prophylaxis is safe, effective and saves lives and money.

As a lawyer who acts on behalf of those who have suffered catastrophic injuries as a result of GBS infection I sincerely hope that further studies can be funded and undertaken and I fully support the Group B Strep Support charity in campaigning for a national screening programme to be introduced within the UK.

If you have any questions about this blog, or Group B Strep generally, please get in touch.

(1) BMJ Open Vol.7 Issue 4 Outcome of a screening programme for the prevention of a neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit: an observational study. G Gopal Rao et al

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