Group B Strep in Pregnancy – How to Support Your Microbiome
In this blog post, I want to take a look at a really important and popular topic in pregnancy and birth. We’re going to dive deep into the topic of GBS (Group B Strep) in pregnancy and the importance of supporting your microbiome throughout the childbearing year.
Group B Strep is one of the most topics I am asked about by clients, students, and the world at large. I always find myself answering questions about this topic whether it’s in birth strategy sessions or through social media.
I wanted to talk about this today to not only talk about Group B Strep in pregnancy and birth, but to emphasize that this is really a holistic issue in our lives that involves more than just pregnancy.
What is Group B Strep?
The topic of Group B Strep typically comes up around at around 36 weeks when most pregnant people are tested for this bacteria. There’s a good chance that you may have never heard of this before. I know that I never heard of it before being tested in my first pregnancy.
GBS stands for Group B Streptococcus. It lives in the intestines of nearly all people at some point. Some people can have an over-colonization of this bacteria, and it can migrate through the digestive and reproductive tracts.
Anywhere from 10-30% of people have a colonization of GBS in their body.
The prenatal care system in the United States recommends testing all people for GBS colonization at around 36 weeks of pregnancy using a vaginal and anal swab. Interestingly, other countries do not recommend routine testing for Group B Strep.
Why is Group B Strep Important?
Group B Strep is a bacteria that can cause illness in all people. Newborns are particularly at risk for a variety of infections including meningitis, pneumonia, and sepsis as a result of a GBS infection.
In pregnancy, testing positive for GBS simply means that you have a colonization of the bacteria in your body. Most people do not have any symptoms of infection or colonization.
People who experience preterm labor are nearly twice as likely to be colonized by GBS.
GBS can cause urinary tract infections and infections in your newborn.
How does a GBS infection occur?
When a birthing person is positive for GBS, the bacteria can move through the vagina to their baby through the amniotic fluid once their water breaks. Most infants that develop a GBS infection are diagnosed within an hour of birth, which suggests that this infection begins before birth.
A baby can swallow some of this amniotic fluid that contains the GBS bacteria and develop an infection in their lungs. Also, a baby can pick up a GBS colonization that does not turn into an infection through their skin as they pass through the birth canal. The vast majority of colonized infants are born healthy.
What are the policies, procedures, and protocols for Group B Strep in pregnancy?
In the early 1990’s, doctors started to recommend testing all pregnant parents for GBS because of this risk of infection.
GBS colonization in late pregnancy is typically treated with IV antibiotics in labor. With the introduction of IV antibiotics in labor, the rate of GBS infections in newborns was reduced from 1.7 infections in 1,000 births (in the 1990’s) to .25 infections in 1,000 births today.
If a person who is colonized with GBS while birthing does not receive antibiotics in labor, the risk of their baby being colonized by Group B Strep is 50%. The risk of developing a life-threatening GBS infection is 1-2%. Most babies who are colonized with GBS stay healthy.
If the a GBS+ birthing person has IV antibiotics in labor, the risk of their baby developing a GBS infection drops from 1% to .2% (an 80% decrease in the risk of infection). This is not ZERO risk.
Of the full term infants who develop a GBS infection at birth, 2 or 3% of those babies will die. This is 2-3 out of 100 babies with a GBS infection. 44% of babies with severe GBS infections will experience life-long health challenges.
What factors increase the risk of GBS infection of a newborn?
- Birth at less than 37 weeks (preterm birth)
- Prolonged rupture of the membranes (when your water breaks long before birth)
- Premature rupture of the membranes (when your water breaks before labor starts)
- Fever in labor
- Infection of the uterus
- Previous GBS infection in an infant
- Intrauterine monitoring (relatively rare but is sometimes used)
- GBS present in the urine
- Having your first baby
BUT we know that 60% of the GBS infections occur with no known risk factors aside from a GBS positive birthing parent
How are people tested for Group B Strep?
Each provider has their own set of preferences for GBS testing. The usual protocol is to test all pregnant parents for GBS between 35-37 weeks of pregnancy. This involves using a swab to collect a sample from the vagina and the rectum. It takes a few days to get the results back. The test is given at this time so that they can theoretically catch any possible GBS infections before labor begins so they can flag these people as needing antibiotics in labor.
The status of GBS colonization in the body is a dynamic state. This means that it can change and morph over time because it’s a living colony. It’s part of how your gut bacteria can change over time. Some strains can be more dominant than others.
Because of this, you can have a positive GBS test at 37 weeks of pregnancy but a negative GBS test in labor (EBB has a really good study that describes the statistics of this). Roughly 80% of people who test positive at 37 weeks will still be positive for GBS at birth. BUT because the body’s microbiome is in a dynamic state, it is still possible for this to change over time.
Statistically speaking, about 20% of people are receiving unnecessary antibiotics in birth based on this research.
What are the choices for treating GBS? What are your options if you’re GBS positive? How is this typically handled?
In the standard medical model, the protocol is to administer IV antibiotics to GBS positive parents in labor every 4 hours, starting at 4 hours before birth. Research has shown that 4 hours is the optimal interval for reaching a therapeutic dose of penicillin in the body. It shows the greatest reduction in GBS bacteria at this time.
It’s important to note that antibiotics in labor does not reduce the risk of GBS to zero. Even if you receive antibiotics in labor, 12% of birthing people still have a GBS colonization at birth. We’re going to talk about this in a bit but I want you to remember this.
Antibiotics & the Infant Microbiome
One of the most common concerns for parents who are GBS positive or are interested in this topic in general is that they are concerned about the effects of antibiotics on their baby’s microbiome and gut health. Nearly all studies reveal that antibiotics in labor temporarily reduce the amount of an infant’s beneficial bacteria and increase the presence of harmful bacteria.
Some studies show that the balance of beneficial bacteria and the gut health effects are still present at 3 months to 1 year of age. But it’s important to point out that our body’s bacteria balance is DYNAMIC and our body has the ability to heal over time with proper care.
And yet another study…
One of the best studies (thank you Evidence Based Birth) showed that infants who were exposed to antibiotics in labor showed a decrease in beneficial bacteria and a decrease in the richness of the bacteria in their microbiome at 3 months. The most severe imbalances were found when the infant was born through a cesarean, which those infants also having higher levels of harmful bacteria Clostridium, Enterococcus, and Streptococcus. In those infants who were born through cesarean who were not breastfed, these effects were present beyond 3 months of age.
The Risk-Based (Awareness) Approach to Group B Strep
Another way this can be handled, which is often seen in other countries, is to be aware of certain signs and risk factors for GBS infections. This includes prolonged rupture of the membranes (if your water has been broken 18+ hours), preterm labor, and previous history for example. If you are experiencing certain risk factors and you are GBS +, you could decide to have antibiotics in labor to reduce the risk of your baby developing an infection.
A Holistic Approach to Group B Strep
A lot of the information circulating about GBS has to do with your choices about what to do when you’re ALREADY highly colonized with GBS. Remember, GBS over-colonization reflects an imbalance in our microbiome, which affects our health and well-being as well as our baby’s.
In a holistic approach to GBS management, it’s better to focus on supporting your microbiome from preconception and throughout your pregnancy so that you don’t have an over-colonization of GBS in the first place. It’s the ultimate prevention. Improving your personal gut health and microbiome reduces your risk of having to deal with GBS at all.
Research on Probiotics and GBS
In one study, probiotics such as lactobacilli strongly inhibited the growth of GBS.
In another study, 43% of people who were GBS+ at 35 weeks tested negative at birth after taking probiotics.
And yet another study showed that people who had higher levels of probiotics such as lactobacilli in their vagina had lower levels of GBS.
So, we have a wealth of information that suggests that supporting your gut health with probiotics in pregnancy can reduce your risks of GBS colonization. You can support your microbiome through foods such as:
- fermented vegetables (like kim chi, sauerkraut, etc.)
- cultured foods
- probiotic supplements
Be Aware of Quick Fixes…
One thing that I see a lot are these quick fix methods to cleanse your vagina or somehow “trick” your GBS test into being negative. There are a few herbal protocols out there and some cleanses that people use. The problem is that they may temporarily wipe out the GBS bacteria when you test, or perhaps after you have a positive test. But it’s really not going to do anything in the long term to support your health and you might still end up recolonized by GBS by the time you give birth.
So you have to ask yourself, what is your goal? Are you just trying to pass a test? Or, are you really looking to improve your overall health and wellness, which ultimately translates to your baby’s health and wellness.
Other Impacts of the Microbiome in Pregnancy
There is a significant correlation between having healthy strains of gut bacteria and weight gain in pregnancy and infant birth weight. One study looked at a TON of data about the microbiomes of pregnant people. This study found that certain healthy strains of bacteria were directly correlated to healthy pregnancy weight gain and healthy infant birth weights.
This happens because having a healthy microbiome in pregnancy supports how your body absorbs nutrients from your food. It also helps you stay healthy and support healthy growth of your baby.
We also know that healthy microbiome bacteria is important to support your mental health as well.
The Microbiome in Children
In children, gut health and the microbiome are implicated in a variety of conditions. This includes autism, ADHD, allergies, immune system dysfunction, learning and mood regulation, and more.
Supporting your microbiome throughout the childbearing year is one of the best things you can to do support family wellness and reduce the risk of issues such as Group B Strep infection.
If you support your gut health now, there’s a pretty good chance that you’re not going to have to worry about GBS at all.
As you know, I’m a holistic doula, and I like to look at the big picture of wellness when it comes to choices in pregnancy and parenting. I want you to follow your own compass as you make these decisions in pregnancy and birth. I want you to have a healthy pregnancy and birth through mind-body-spirit wellness. I’m not a medical professional or any kind of midwife. BUT I do think it’s totally aligned and reasonable for me to say that your best chance at reducing the risk of having a GBS colonization in the first place is to support your own gut health and microbiome in pregnancy.
Want to learn more? Do you want to connect with me? Check out my Facebook group called Follow Your Own Compass! It’s a group for parents just like you who want to follow their own compass in pregnancy and birth.
I have an amazing new course I just launched called the Blissful Birth Mini-Course. This course lays the foundation for a confident, peaceful, and powerful birth. I teach this course through my strategy called the 3 R’s – relaxation, ritual, and radical love. Check out this online course to help you have a confident and powerful birth! I’m offering this course to you at just $7, although the resources in it are worth $57. Check it out today!