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Analysis

Universal antenatal screening for group B streptococcus may cause more harm than good

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l463 (Published 20 February 2019) Cite this as: BMJ 2019;364:l463
  1. Farah Seedat, doctoral candidate1,
  2. Julia Geppert, research fellow1,
  3. Chris Stinton, senior research fellow1,
  4. Jacoby Patterson, clinical effectiveness reviewer1,
  5. Karoline Freeman, research fellow1,
  6. Samantha Ann Johnson, academic support librarian1,
  7. Hannah Fraser, research associate1,
  8. Colin Stewart Brown, consultant microbiologist2,
  9. Olalekan A Uthman, associate professor1,
  10. Bee Tan, professor4,
  11. Esther R Robinson, lead public health microbiologist3,
  12. Noel Denis McCarthy, professor1,
  13. Aileen Clarke, professor1,
  14. John Marshall, evidence lead5,
  15. Cristina Visintin, senior evidence review manager5,
  16. Anne Mackie, professor5,
  17. Sian Taylor-Phillips, associate professor1
  1. 1Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
  2. 2Bacteria Reference Department, National Infection Service, Public Health England, London, UK
  3. 3Field Service, National Infection Service, Public Health England, Nottingham, UK
  4. 4Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK
  5. 5UK National Screening Committee, London, UK
  1. Correspondence to: S Taylor-Phillips s.taylor-phillips{at}warwick.ac.uk

Based on current evidence, routine screening for group B streptococcus colonisation in late pregnancy should not be introduced in the UK, as the potential harms of unnecessary treatment with antibiotics may outweigh the benefits, argue Farah Seedat and colleagues

Key messages

  • Early onset group B streptococcus (GBS) disease is an important health problem and efforts should continue to better understand and prevent it

  • Selective maternal culture is not an accurate test to predict early onset GBS disease in neonates, and we don’t know why some colonised mothers have a neonate with early onset GBS and others don’t

  • The current approach to screening would lead to 99.8% of screen positive women and their babies receiving unnecessary intrapartum antibiotic prophylaxis

  • Lack of high quality evidence on clinical outcomes makes it impossible to quantify whether universal GBS screening would have any benefit and assess whether large scale intrapartum antibiotic prophylaxis is safe

  • A universal antenatal culture screening programme cannot currently be recommended

Group B streptococcus (Streptococcus agalactiae, GBS) is the most common cause of neonatal sepsis and meningitis in many developed countries.1 In the UK, GBS causes invasive disease in the first six days of life (early onset GBS infection) in around one of every 2000 live births.2 To prevent early onset disease, intrapartum antibiotic prophylaxis, usually intravenous penicillin, is the recommended treatment internationally. The UK recommends a risk based strategy, whereby pregnant women presenting with risk factors for early onset GBS infection are offered antibiotic prophylaxis in labour.3456

The media and politicians regularly call for universal antenatal screening for GBS as an alternative means of selecting women for prophylaxis. Advocates point to countries across Europe and North America where screening is recommended78910111213141516171819 and where reductions …

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