Risk Factors For Recurrence Of Gbs In A Subsequent Pregnancy

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Risk Factors For Recurrence Of Gbs In A Subsequent Pregnancy

  1. 1. Risk Factors for Recurrence of Group B Streptococcus Colonization in a Subsequent Pregnancy ○ ● ● ● ○ ● Shang-Yu Huang, MD, Po-Jen Cheng, MD Linko Chang-Gung Memorial Hospital Taiwan
  2. 2. Introduction
  3. 3. ○ ● ● ● ○ ●
  4. 4. ○ ● ● ● ○ ● CGMH Protocol of GBS Screen Universal screening of rectovaginal colonization of GBS in 35 ~37 weeks of gestation * <ul><li>IAP indication: </li></ul><ul><li>Previous infant with GBS </li></ul><ul><li>GBS bacteriuria in current pregnancy </li></ul><ul><li>Positive screening results except those for planned cesarean section without labor </li></ul><ul><li>Unknown GBS status and </li></ul><ul><ul><li>Delivery < 37 weeks of gestation or </li></ul></ul><ul><ul><li>ROM> 18 hours or </li></ul></ul><ul><ul><li>Intrapartum fever ≧ 38℃ </li></ul></ul><ul><li>Not IAP indication: </li></ul><ul><li>Previous positive screening result (except current positive screening ) </li></ul><ul><li>Planned cesarean section without labor or ROM </li></ul><ul><li>Negative screening results in current pregnancy </li></ul>* Except those with previous infant with GBS and GBS bacteriuria in current pregnancy
  5. 5. <ul><li>Recurrence rates in a subsequent pregnancy </li></ul><ul><li>Evaluating factors predictive for recurrent maternal GBS colonization among these women. </li></ul>We want to know
  6. 6. Materials and Methods
  7. 7. Subjects <ul><li>Retrospective chart review from January 2002 to December 2006 </li></ul><ul><li>Prenatal GBS screening culture is performed between 35 and 37 weeks of gestation </li></ul><ul><li>Exclusion criteria : </li></ul><ul><ul><li>With clinical GBS bacterial infection during the index or subsequent pregnancy </li></ul></ul><ul><ul><li>With previous delivery of an infant with early-onset GBS disease </li></ul></ul>○ ● ● ● ○ ●
  8. 8. Laboratory procedure <ul><li>Vaginal and rectal swabs specimen collected separately </li></ul><ul><li>Amines transport medium (Copan ltalia, Brescia, Italy) </li></ul><ul><li>Non-enriched and selective LIM broth medium at 36±1℃ in 36 hours </li></ul><ul><li>An aliquot in plated onto 5% sheep blood agar </li></ul><ul><li>24 hours later, potential GBS colonies are evaluated according to morphology and the presence of hemolysis </li></ul><ul><li>If not GBS identified, the plate will be reincubated and inspected 48 hours later </li></ul><ul><li>Mueller Hinton Agar for antimicrobial susceptibility testing (Oxoid, Unipath Ltd, Basingstoke, UK) </li></ul><ul><li>Intensity of GBS </li></ul>○ ● ● ● ○ ●
  9. 9. ○ ● ● ● ○ ●
  10. 10. Variables evaluation <ul><li>Index pregnancy – </li></ul><ul><ul><li>Maternal age, marital status, pre-pregnancy weight, weight gain during pregnancy, infant birth weight, breast-feeding, result of gestational diabetes mellitus (GDM) screening, intensity of GBS colonization. </li></ul></ul><ul><li>Subsequent pregnancy – </li></ul><ul><ul><li>Pre-pregnancy weight, smoking, GDM screening </li></ul></ul><ul><li>Time interval between the two pregnancies (months) </li></ul><ul><li>Ethnicity </li></ul>○ ● ● ● ○ ●
  11. 11. Statistic <ul><li>SPSS 11.0 statistical package (SPSS Inc., Chicago, IL, USA) </li></ul><ul><li>Possible predictors was analyzed relative risks (RRs) and 95% confidence intervals (CIs) in univariable fashion </li></ul><ul><li>Potential predictors were analyzed in step-wise logistic regression </li></ul><ul><li>Pairwise comparison (chi-square and student’s t-test ) </li></ul><ul><li>Two-sided P < 0.05 </li></ul>○ ● ● ● ○ ●
  12. 12. Results
  13. 13. Table I – Univariable associations between recurrent GBS colonization and factors from the index and subsequent pregnancy. 70 181 29 222 24 89 121 17 Maternal age: index pregnancy (years) -- 1.00 5 (29.4) < 20 (0.98~1.87) 1.38 49 (40.5) 20-29 (0.81~1.76) 1.22 32 (36.0) 30-39 (0.96~1.93) 1.42 10 (41.7) ≧ 40 Marital status: index pregnancy -- 1.00 84 (37.8) Married (0.79~1.63) 1.10 12 (41.4) Single Ethnicity: -- 1.00 67 (37.0) Taiwanese (0.77~1.81) 1.12 29 (41.4) Foreign-born N 95% CI RR ‡ (unadjusted) Recurrence of GBS: n (%) † Variable *
  14. 14. Table I – Univariable associations between recurrent GBS colonization and factors from the index and subsequent pregnancy. –cont. N 95% CI RR ‡ (unadjusted) Recurrence of GBS: n (%) † Variable * (0.82~1.39) 0.98 16 (40.0) 40 ≧ 60 kg (0.71~1.27) 0.91 28 (37.3) 75 50-59 kg (0.65~1.23) 0.90 32 (36.8) 87 40-49 kg -- 1.00 20 (40.8) 49 < 40 kg Pre-pregnancy weight: index pregnancy (1.03~1.83) 1.47 20 (52.6) 38 Yes -- 1.00 76 (35.7) 213 No Smoking: subsequent pregnancy
  15. 15. Table I – Univariable associations between recurrent GBS colonization and factors from the index and subsequent pregnancy. –cont. N 95% CI RR ‡ (unadjusted) Recurrence of GBS: n (%) † Variable * 51 73 92 35 Pre-pregnancy weight: subsequent pregnancy -- 1.00 14 (40.0) < 40 kg (0.77~1.42) 0.98 36 (39.1) 40-49 kg (0.83~1.39) 0.93 27 (37.0) 50-59 kg (0.79~1.44) 0.93 19 (37.3) ≧ 60 kg (0.87~1.46) 1.11 11 (42.3) 26 ≧ 4000 kg (0.59~1.61) 0.99 77 (37.7) 204 2500-3999 kg -- 1.00 8 (38.1) 21 < 2500 kg Birth weight: index pregnancy
  16. 16. Table I – Univariable associations between recurrent GBS colonization and factors from the index and subsequent pregnancy. –cont. N 95% CI RR ‡ (unadjusted) Recurrence of GBS: n (%) † Variable * 30 79 118 24 Weight gain during pregnancy: index pregnancy -- 1.00 9 (37.5) < 5 kg (0.72~1.46) 1.09 48 (40.7) 5-9 kg (0.65~1.28) 0.94 28 (35.4) 10-14 kg (0.69~1.38) 0.98 11 (36.7) ≧ 15 kg (0.58~1.60) 0.94 30 (36.6) 82 No -- 1.00 66 (39.1) 169 Yes Breast-feeding: index pregnancy
  17. 17. Table I – Univariable associations between recurrent GBS colonization and factors from the index and subsequent pregnancy. –cont. N 95% CI RR ‡ (unadjusted) Recurrence of GBS: n (%) † Variable * 16 62 69 104 Time interval between index and subsequent pregnancies (months) -- 1.00 32 (30.8) ≧ 36 (0.79~1.68) 1.27 27 (39.1) 24-35 (1.01~1.99) 1.47 28 (45.2) 12-23 (1.20~2.71) 1.83 9 (56.3) < 12 (1.04~1.98) 1.42 16 (51.6) 31 Positive -- 1.00 80 (36.4) 220 Negative GDM screening: index pregnancy
  18. 18. Table I – Univariable associations between recurrent GBS colonization and factors from the index and subsequent pregnancy. –cont. 154 N 95% CI RR ‡ (unadjusted) Recurrence of GBS: n (%) † Variable * 52 40 211 GDM screening: subsequent pregnancy -- 1.00 75 (35.5) Negative (1.09~2.11) 1.48 21 (52.5) Positive Intensity of GBS colonization: index pregnancy -- 1.00 15 (28.8) Light (1.21~2.89) 1.85 24 (53.3) 45 Heavy (0.85~1.79) 1.28 57 (37.0) Moderate
  19. 19. Summary of table I <ul><li>Of the total 251 women in this study, 96 (38.2%) had GBS colonization during the subsequent pregnancy (95% CI 33.5~42.9%) </li></ul><ul><li>Four potential predictors were </li></ul><ul><ul><li>GDM screening result (index/subsequent pregnancy) </li></ul></ul><ul><ul><li>Intensity of GBS colonization for the index pregnancy </li></ul></ul><ul><ul><li>Smoking during subsequent pregnancy </li></ul></ul><ul><ul><li>Time interval between two pregnancies </li></ul></ul>○ ● ● ● ○ ●
  20. 20. Table II –Predictive factors for recurrence of GBS colonization (multivariable model). (1.2~2.6) 1.7 25 (53.3) Heavy (0.8~1.9) 1.2 57 (37.0) Moderate 1.0 15 (28.8) Light Intensity of GBS colonization: index pregnancy (1.1~2.4) 1.6 9 (56.3) < 12 (0.9~2.1) 1.3 28 (45.2) 12-23 (0.7~1.9) 1.2 27 (39.1) 24-35 1.0 32 (30.8) ≧ 36 Time interval between index and subsequent pregnancies (months) Adjusted RR † (95% CI) Recurrence of GBS: n (%) * Variable
  21. 21. Discussion
  22. 22. <ul><li>This study describes rate of recurrent GBS around 38.2% , which was much higher than the incident rate of maternal colonization in our institutions (18.3%) and other local study in Chinese women (11.1%) </li></ul><ul><li>Besides, shorter inter-pregnancy interval and heavy GBS intensity may be predictors for recurrent GBS colonization in a subsequent pregnancy </li></ul><ul><li>Therefore, intrapartum antibiotics treatment should also be considered in those pregnancies whose GBS status is unknown at the time of labor but with these two predictor </li></ul>○ ● ● ● ○ ●
  23. 23. <ul><li>The information on risk factors for recurrent GBS colonization will also assist health care providers in counseling women with GBS colonization about their risk for recurrence, the importance of appropriate prenatal GBS screening, and intrapartum antibiotics treatment for unknown GBS status in any subsequent pregnancy. </li></ul>○ ● ●
  24. 24. Thanks for your attention

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