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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (5): 669-674    DOI: 10.31083/j.ceog.2020.05.5411
Original Research Previous articles | Next articles
Detection of group B streptococcus colonization in cervical and lower vaginal secretions of pregnant women
Y.X. Wang1, 2, M. Zhong1, *(), H. Yi2, H.F. He2
1Nanfang Hospital of Southern Medical University, Guangzhou, 510515, P.R. China
2Shenzhen Futian Maternal and Child Health Hospital, Shenzhen, 518045, P.R. China
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Abstract  

Objective: To examine the efficacy of cervical and lower vaginal secretions in the detection of group B streptococcus (GBS) colonization in women in early and late pregnancy. Materials and Methods: Two-thousand women in early pregnancy (8-12 weeks of gestation) aged approximately 27 years who visited our outpatient clinic from December 2016 to December 2018 were enrolled. Cervical and lower vaginal secretions were obtained at 8-12 weeks (early pregnancy) and then at 37 weeks (late pregnancy) of gestation and screened for GBS infection. Patients were classified as follows: (i) cervical and lower vaginal secretions were GBS-positive (group A), (ii) only cervical secretions were GBS-positive (group B), (iii) only lower vaginal secretions were GBS-positive (group C), and (iv) both cervical and lower vaginal secretions were GBS-negative (group D). Results: No difference in the GBS-positive rate was observed between women in early and late pregnancy. The GBS-positive detection rate was lower in women from which cervical secretions were screened than that in women from which lower vaginal secretions were assayed; however, the incidence rates of adverse pregnancy events, such as abortion, preterm delivery, premature rupture of membranes and neonatal infection, were higher in women in which cervical secretions were assayed. Conclusion: Women in early pregnancy should be screened for GBS infection using cervical secretions.

Key words:  Pregnancy      Group B streptococcus      Cervical secretions      Vaginal secretions      Neonate     
Submitted:  16 October 2019      Accepted:  09 June 2020      Published:  15 October 2020     
Fund: 
FTWS2018034/Public welfare fund project in Shenzhen, Futian District
*Corresponding Author(s):  M. Zhong     E-mail:  zhongmei20189@163.com

Cite this article: 

Y.X. Wang, M. Zhong, H. Yi, H.F. He. Detection of group B streptococcus colonization in cervical and lower vaginal secretions of pregnant women. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 669-674.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.05.5411     OR     https://ceog.imrpress.com/EN/Y2020/V47/I5/669

Figure 1.  — The flow chart of this study.

Table 1  — General information of pregnant women.
Group Cases (n) Age (years) BMI (Kg/m2) Gestational Weeks (w) Medical Illness (n) Parity (n)
A 62 29.58 ± 5.79 22.75 ± 2.71 10.0 ± 1.5 3.72 ± 2.01 1.83 ± 0.93
B 69 28.98 ± 4.92 22.82 ± 2.83 9.8 ± 1.3 4.83 ± 2.34 2.03 ± 1.02
C 123 29.50 ± 5.77 22.28 ± 3.11 9.6 ± 1.1 6.77 ± 3.12 1.95 ± 0.85
D 1746 28.95 ± 5.12 23.01 ± 3.01 9.7 ± 1.2 69.84 ± 11.45 2.01 ± 1.05
F --- 0.696 2.41 1.693 2650 0.727
p --- 0.5545 0.0652 0.1664 0.9958 0.5361
Table 2  — Comparison of the rate of pregnant women, abortion and premature delivery among the four groups women in early pregnancy.
Group Pregnant women
n (%) (n = 2000)
Abortion n (%)
(n = 33)
Premature delivery n (%)
(n = 115)
A 62 (3.1)
69 (3.45)
123 6.15)
1746(87.3)
3 (4.48)
4 (5.80)
3 (2.44)
23 (1.32)
9(14.52)
9 (13.04)
8 (6.50)
89 (5.10)
B
C
D
χ2 --- 12.0514 14.2272
p --- 0.0072 0.0026
Table 4  — Comparison of GBS positive rate of pregnant women in early and late pregnancy.
Gestational Weeks
(w)
Cases
(n)
GBS Positive Cases GBS Negative Cases χ2 p
n (%) n (%)
8-12 2000 254 (12.70) 1746 (87.30) 0.0016 0.9681
37 1852 236 (12.74) 1616 (87.26)
Table 3  — Cases of four groups women at the 37th gestation week and consequent PROM and neonatal infection events.
Group Pregnant Women
n (%) (n = 1852)
PROM Events
n (%) (n = 187)
Neonatal Infection Events
(GBS infection) n (%) (n = 4)
A 56 (3.02) 13 (23.21) 1 (1.79)
B 57 (3.08) 14 (24.56) 1 (1.75)
C 123 (6.64) 20 (16.26) 2 (1.63)
D 1616 (87.26) 140 (8.63) 0 (0.00)
χ2 --- 24.2339 27.0466
p --- 0.0000 0.0000
Table 5  — The final outcome of four groups women.
Group Cases (n) Termination of Gestational Weeks (w) Neonatal Weight
(Kg)
Neonatal GBS Carriers n (%) Neonatal GBS Infectors n (%) Neonatal Intensive Care Cases n (%)
A 62 38.4 ± 0.65 3.296 ± 0.4268 6 ( 9.68) 2 (3.23) 2 (3.23)
B 69 38.3 ± 0.47 3.312 ± 0.5716 6 (8.70) 2 (2.90) 1 (1.45)
C 123 38.5 ± 0.39 3.2302 ± 0.5605 10 (8.13) 6 (4.88) 2 (1.63)
D 1746 38.6 ± 0.55 3.310 ± 0.4989 0 (0) 7 (4.01) 5 (2.86)
F2 --- 18.23 0.025 --- 33.8120 14.8094
p --- 0.9205 0.9947 < 0.01 < 0.01 0.0020
[1] Edmond K.M., Kortsalioudaki C., Scott S., Schrag S.J., Zaidi A.K.M., Cousens S., et al.: "Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis". Lancet, 2012, 379, 547-556.
doi: 10.1016/S0140-6736(11)61651-6
[2] Verani J.R., McGee L., Schrag S.J.: "Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010". MMWR Recomm. Rep., 2010, 59, 1-36.
pmid: 20224546
[3] Kenchington A.L., Lamont R.F.: "Group B streptococcal immunisation of pregnant women for the prevention of early and late onset Group B streptococcal infection of the neonate as well as adult disease". Expert Rev. Vaccines, 2016, 16, 15-25.
doi: 10.1080/14760584.2016.1209113 pmid: 27385362
[4] Lu B., Li D., Cui Y., Sui W., Huang L., Lu X.: "Epidemiology of Group B streptococcus isolated from pregnant women in Beijing, China". Clin. Microbiol. Infect., 2014, 20, O370-373.
doi: 10.1111/1469-0691.12416 pmid: 24118553
[5] Brigtsen A.K., Jacobsen A.F., Dedi L., Melby K.K., Fugelseth, D., Whitelaw, A.: "Maternal Colonization with Group B Streptococcus Is Associated with an Increased Rate of Infants Transferred to the Neonatal Intensive Care Unit". Neonatology, 2015, 108, 157-163.
doi: 10.1159/000434716 pmid: 26182960
[6] Le Doare K., Heath P.T.: "An overview of global GBS epidemiology". Vaccine, 2013, 31 Suppl 4, D7-12.
doi: 10.1016/j.vaccine.2013.01.009
[7] Liu H., Zeng H., Wang W., Deng Q., Margarit I., Rinaudo C.D., et al.: "Estimating the burden of invasive Group B Streptococcal disease in young infants in southern mainland China: an observational study". Int. J. Clin. Exp. Med., 2015, 8, 13699-13707.
pmid: 26550315
[8] Francioli P., Vaudaux B., Glauser M.P.: "Streptococcus group B septicemia. Analysis of 18 cases in adults and 10 in newborn infants". Schweiz. Med. Wochenschr., 1983, 113, 38-41.
pmid: 6338580
[9] Nizet V., Doran K.S. (2013) Group B Streptococcus meningitis (CABI) pp 118-132.
[10] Pacha A., Luna Cian R., Bonofiglio L., Solari M., Strada V., Suárez M., et al.: "Group B streptococcal necrotizing pneumonia in a diabetic adult patient". Rev. Argent. Microbiol., 2017, 49, 139-141.
doi: 10.1016/j.ram.2016.09.005 pmid: 28325626
[11] Zilberman D., Williams S.F., Kurian R., Apuzzio J.J.: "Does genital tract GBS colonization affect the latency period in patients with preterm premature rupture of membranes not in labor prior to 34 weeks?". J. Matern. Fetal Neonatal Med., 2014, 27, 338-341.
doi: 10.3109/14767058.2013.816279 pmid: 23777279
[12] Randis T.M., Gelber S.E., Hooven T.A., Abellar R.G., Akabas L.H., Lewis E.L., et al.: "Group B Streptococcus β-hemolysin/cytolysin breaches maternal-fetal barriers to cause preterm birth and intrauterine fetal demise in vivo". J. Infect. Dis., 2014, 210, 265-273.
doi: 10.1093/infdis/jiu067 pmid: 24474814
[13] Park H.R., Harris S.M., Boldenow E., McEachin R.C., Sartor M., Chames M., et al.: "Group B streptococcus activates transcriptomic pathways related to premature birth in human extraplacental membranes in vitro". Biol. Reprod., 2018, 98, 396-407.
doi: 10.1093/biolre/iox147 pmid: 29155939
[14] Bianchi-Jassir F., Seale A.C., Kohli-Lynch M., Lawn J.E., Baker C.J., Bartlett L., et al.: "Preterm birth associated with group B streptococcus maternal colonization worldwide: systematic review and meta-analyses". Clin. Infect. Dis., 2017, 65, S133-s142.
doi: 10.1093/cid/cix661 pmid: 29117329
[15] Weintraub A., Wiznitzer A., Sergienko R., Salem S.Y., Press F., Sheiner E.: "A linear association exists between the location of GBS colonization and adverse pregnancy outcomes". Am. J. Obstet. Gynecol., 2009, 201, S234-S235.
[16] Berardi A., Cattelani C., Creti R., Berner R., Pietrangiolillo Z., Margarit I., et al.: "Group B streptococcal infections in the newborn infant and the potential value of maternal vaccination". Expert Rev. Anti Infect. Ther., 2015, 13, 1387-1399.
doi: 10.1586/14787210.2015.1079126 pmid: 26295167
[17] Li S., Huang J., Chen Z., Guo D., Yao Z., Ye X.: "Antibiotic prevention for maternal group B streptococcal colonization on neonatal GBS-related adverse outcomes: a meta-analysis". Front. Microbiol., 2017, 8, 374.
doi: 10.3389/fmicb.2017.00374 pmid: 28367139
[18] Listed N.: "GBS testing during pregnancy". Am. Fam. Physician, 2012, 86, 1.
pmid: 22962936
[19] Yang L., Shi C.: "Screening and treatment of group B streptococcus in pregnancy". Chinese J. Obstet. Emerg., 2017, 7, 160-167.
[19] [In Chinese]
[20] Kalpakçı P., Benli A.R., Erturhan S., Demirel, Y.: "The frequency of rectovaginal group B streptococci in third trimester pregnant women and affecting factors". J. Contemp. Med., 2017, 160-167.
[21] Gong M.X., Dan D.U., Pan D.N.: "Risk factors of group B Streptococcus among late pregnant women and its effect on pregnancy outcomes". Matern. Child Heal. Care China, 2017, 32, 2902-2904. [In Chinese]
[22] Anonymous (2019) Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 782. in Obstet Gynecol, pp e19-e40.
[23] Berardi A., Rossi C., Guidotti I., Vellani G., Lugli L., Bacchi, Reggiani M.L., et al.: "Factors associated with intrapartum transmission of group B Streptococcus". Pediatr. Infect. Dis. J., 2014, 33, 1211-1215.
doi: 10.1097/INF.0000000000000439
[24] Vornhagen J., Adams, Waldorf K.M., Rajagopal, L.: "Perinatal group B streptococcal infections: virulence factors, immunity, and prevention strategies". Trends Microbiol., 2017, 25, 919-931.
doi: 10.1016/j.tim.2017.05.013 pmid: 28633864
[25] Lin S.M., Jang A.Y., Zhi Y., Gao S., Lim S., Lim J.H., et al.: "Vaccination with a latch peptide provides serotype-independent protection against group B streptococcus infection in mice". J. Infect. Dis., 2017, 217, 93-102.
pmid: 29106586
[26] Chen S.S., Chen H., Yu F.Y., Zhang X.Q., Center L.M.: "Prevalence and antimicrobial susceptibility of group B Streptococci in reproductive tracts of women". Chinese J. Clin. Pharmacol., 2016, 32, 1766-1768.
[26] [In Chinese]
[27] Hordnes K., Tynning T., Brown T.A., Haneberg B., Jonsson R.: "Nasal immunization with group B streptococci can induce high levels of specific IgA antibodies in cervicovaginal secretions of mice". Vaccine, 1997, 15, 1244-1251.
doi: 10.1016/s0264-410x(97)00021-2 pmid: 9286051
[28] Berg B.R., Houseman J.L., Garrasi M.A., Young C.L., Newton D.W.: "Culture-based method with performance comparable to that of PCR-based methods for detection of group B Streptococcus in screening samples from pregnant women". J. Clin. Microbiol., 2013, 51, 1253-1255.
doi: 10.1128/JCM.02780-12
[29] Rallu F., Barriga P., Scrivo C., Martel-Laferrière V., Laferrière C.: "Sensitivities of antigen detection and PCR assays greatly increased compared to that of the standard culture method for screening for group B streptococcus carriage in pregnant women". J. Clin. Microbiol., 2006, 44, 725-728.
doi: 10.1128/JCM.44.3.725-728.2006 pmid: 16517846
[30] Rosa C., Clark P., Duff P.: "Performance of a new DNA probe for the detection of group B streptococcal colonization of the genital tract". Obstet. Gynecol., 1995, 86, 509-511.
doi: 10.1016/0029-7844(95)00199-2 pmid: 7675370
[31] Artz L.A., Kempf V.A., Autenrieth I.B.: "Rapid screening for Streptococcus agalactiae in vaginal specimens of pregnant women by fluorescent in situ hybridization". J. Clin. Microbiol., 2003, 41, 2170-2173.
doi: 10.1128/jcm.41.5.2170-2173.2003 pmid: 12734271
[32] Benson J.A., Ferrieri P.: "Rapid pulsed-field gel electrophoresis method for group B streptococcus isolates". J. Clin. Microbiol., 2001, 39, 3006-3008.
doi: 10.1128/JCM.39.8.3006-3008.2001 pmid: 11474035
[33] Feld S.M., Aikman N.M., Laubach G.E., Harrigan J.T., Kadar N.R.: "Efficacy of the gram stain and a rapid ELISA test in screening for group B streptococcus". J. Matern-Fetal Med., 1993, 2, 21-24.
doi: 10.3109/14767059309017219
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