Since the early 1970's, the bacteria Group B
Streptococcus (GBS) has been identified as
the number one cause of life threatening infections
in newborn babies.
This bacteria is normally found in the vagina
and/or lower intestine of 15% to 40% of all
healthy, adult women. Those women who test
positive for GBS are said to be colonized.
Group B Streptococcus should not be confused
with Group A Streptococcus which causes strep
The vast majority of GBS infections are acquired
during childbirth when the baby comes into
direct contact with the bacteria carried by
An estimated 12,000 infants in the United States
will become infected with GBS each year. This
bacteria will result in the death of an estimated
2,000 infants yearly, while leaving many others
mentally and/or physically handicapped.
GBS usually causes infant illness within the
first seven days of life, but late onset infections
may occur up to three months of age. Performance
of a cesarean section will not eliminate the
risk of infection.
GBS infections are more common than other illnesses
for which pregnant women are screened, such
as rubella, Down's Syndrome and spina bifida.
Yet, GBS remains generally unknown to the public.
Fortunately, there is testing and a preventative
treatment available that can help prevent many
of these infections.
ENCLOSED ARE SOME INFORMATIVE FACTS ABOUT:
the testing available to identify women
who carry GBS;
an effective treatment that can help prevent
many of these infections;
future hopes for a vaccine;
a nonprofit organization that can provide
additional information to pregnant women,
prospective parents, families and their
GBS AND PREGNANCY
"Do All Women Carry GBS?"
If 1000 women, regardless of race or socioeconomic
status, had a vaginal culture taken, 150-350
would test positive for GBS. Because GBS usually
does not cause problems for the adult female,
most women carry it and do not know it. Yet,
GBS can cause serious illness in babies born
to women who carry the bacteria.
"Is GBS a Sexually Transmitted Disease?"
Since GBS is normally found in the vagina and/or
rectum of colonized women, one way it can colonize
another individual is through sexual contact.
However, this bacteria usually does not cause
genital symptoms or discomfort and is generally
not linked with increased sexual activity.
Therefore GBS is not considered to be a sexually
"How Common Are GBS Infections?"
Out of every 1000 births, three babies will
become ill with GBS. Why only certain infants
fall victim to this infection is not completely
known. An estimated 12,000 babies will suffer
from GBS infections each year.
"What Complications Does GBS Cause?"
Most often, GBS colonizes the baby during labor
either by traveling upward from the mother's
vagina into the uterus, or as the infant passes
through the birth canal. Illness occurs when
the bacteria enters the baby's blood stream.
This can then lead to shock, pneumonia, and
meningitis (an infection of the baby's spinal
fluid and brain tissue). In certain cases,
evidence exists that GBS may cross intact membranes
to infect the baby in utero. All of these conditions
are life threatening. This year alone:
an estimated 2000 babies will die;
large numbers will suffer permanent handicaps
such as brain
damage ranging from mild learning disabilities
to severe mental retardation, loss of
hearing, and lung damage (full statistics
do not exist for the total number of surviving
babies who will have these permanent handicaps);
others will survive with no long-term damage.
GBS is also responsible for causing infections
in nearly 50,000 pregnant women each year including
fever after birth, uterine inflammation, and
infections following cesarean sections.
"When is GBS a Threat?"
GBS can be present in a woman's first pregnancy,
or in following pregnancies. The bacteria can
be a threat both during pregnancy and at the
time of delivery. It has been shown that women
who carry large amounts of the bacteria are
at greatest risk of having a baby infected
with GBS. Also, the occurrence of GBS infections
are increased in certain high risk situations.
HIGH RISK SITUATIONS:
When labor is premature;
When there is premature rupture of the
When there is prolonged rupture of membranes
(>12 hours) before the baby is born;
If the mother has a fever (>100.4 F)
before or during labor;
Women who have a history of GBS in previous
"Can GBS Infections Be Prevented?"
Yes. There is a fast and effective treatment
for many situations. Medical research indicates
that giving antibiotics through the vein to
the mother during labor can greatly reduce
the frequency of GBS infection in the baby
immediately after birth or during the first
week of life.
Treating the mother with oral antibiotics during
the pregnancy may decrease the amount of GBS
for a short time, but it will not eliminate
the bacteria completely and will leave the
baby unprotected at birth. Also, waiting to
treat the baby with antibiotics after birth
is often too late to prevent illness.
"How Do I Know If I Carry GBS?"
Some doctors routinely screen for GBS by doing
cultures on their patients during pregnancy.
These cultures must be taken from the lower
vagina and rectum, not the cervix.
Women who are found to carry the bacteria can
then be treated as potential GBS risk patients.
But, just like any other bacteria in the human
body, GBS can be present in small amounts on
one day which would result in a negative culture.
Therefore, one negative culture result does
not guarantee that you will be negative on
the day you deliver. (Current studies indicate
that a lower vaginal AND rectal culture done
late in pregnancy is more than 93% accurate
in detecting who will not carry the bacteria
"Can I Be Tested Again At The Time Of
A rapid test has been developed that can detect
the presence of GBS from a vaginal swab. This
test can be completed during labor and will
identify women who carry large amounts of GBS.
Infants born to these heavily colonized women
are at greatest risk of infection. Women who
carry less amounts of the bacteria may not
be identified by the test; however, medical
research indicates that their babies are at
lower risk of becoming infected. Although GBS
can strike anyone, infants at greatest risk
of infection are those that fall into the HIGH
RISK SITUATIONS mentioned previously. It is
in these situations that it could be particularly
beneficial to perform the rapid test during
labor to determine of the mother is carrying
"What If My Culture Of Rapid Test Is Positive?"
Because so many women carry GBS, and not all
of their babies become ill, many physicians
believe that antibiotics should not be given
to all women who test positive for the bacteria.
This would result in the unnecessary treatment
of a large number of women. Instead, the focus
is on the high risk patients. If a woman is
found to carry GBS and falls into one or more
of the high risk situations during labor, her
doctor can immediately start antibiotic treatment
which will help protect the baby and the mother.
"Future Hopes For A Vaccine"
Although the focus of GBS testing and treatment
is on high risk infants and mothers, GBS also
strikes infants and mothers who do not appear
to have any risk factors at birth. As a result,
researchers are actively working on the development
of a GBS vaccine which would protect infants
and mothers in the future. Use of the vaccine
in adult women would create an immunity, which
during pregnancy could cross the placenta and
protect the baby. Although widespread use of
a vaccine is still years away, this is the
solution that will protect future babies regardless
of risk factors.
THE CHOICE IS YOURS
No one really knows ahead of time if she will
find herself in a high risk situation during
pregnancy or labor. Now that you are aware
of GBS disease, please take the time to discuss
GBS testing and preventative treatment with
The American Academy of Pediatrics recommends
that all pregnant women be screened for GBS
bacteria between 35 and 37 weeks of pregnancy,
(women who test positive should be offered
antibiotic treatment during labor) and that
all women who have risk factors PRIOR to being
screened for GBS (for example, women who have
preterm labor beginning prior to 37 completed
weeks' gestation) are treated with IV antibiotics
until their GBS status is established.
The Centers for Disease Control state that it
is cost effective to routinely screen pregnant
women for GBS. They further state that is all
women are screened at 35-37 weeks gestation
and all GBS+ moms are treated with IV antibiotics
in labor, more than 3/4 of all cases of GBS
in the first week of life could be prevented.
GROUP B STREP ASSOCIATION
Dedicated to the fight against GBS infection.
Group B Strep Association is a nonprofit organization
formed by parents whose babies were victims
of GBS infections. Having experienced the pain
and devastation of this illness, these parents
sought the help of prominent researchers and
physicians from all over the country. These
doctors responded with great support and have
joined together to act as the Medical Advisory
Board for the organization. Together we hope
to create public awareness of GBS disease,
to bring about guidelines for testing and treatment
of GBS, and to generate continuing support
for vaccine research. Our greatest underlying
purpose is to serve the public by being a resource
for both information and support.
The Group B Strep Association was formed:
In memory of all the babies who have died;
In sympathy for all the babies left handicapped;
For the sake of all the babies yet to come.
The Group B Strep Association does not represent
or endorse any particular manufacturer's product
related to testing or treatment of Group B
B strep: are antibiotics necessary? Mothering, Nov-Dec, 2003, by
Most women who have been pregnant
in the last few years are familiar with the
term group B strep (for group B streptococcus),
or GBS. The American College of Obstetricians
and Gynecologists (ACOG) and the US Centers
for Disease Control and Prevention (CDC) recommend
that all pregnant women be screened between
weeks 35 and 37 of their pregnancies to determine
if they are carriers of GBS. This screening
involves taking a swab of the pregnant woman's
vaginal and rectal areas. Studies show that
approximately 30 percent of pregnant women
ate found to be colonized with GBS in one of
both areas. (1-5)
The CDC and ACOG advise all pregnant
women who are found to be carriers of GBS to
be treated with intravenous antibiotics during
labor. Doctors and midwives have such great
concern because GBS can be passed from the
mother to the infant during delivery and can
cause sepsis (a blood infection), pneumonia,
and meningitis (an infection of the fluid and
lining of the brain) in newborn infants. Therefore,
most pregnant women who test positive for GBS
choose to follow CDC and ACOG recommendations
and attempt to avoid transmitting GBS to their
newborns through treatment with IV antibiotics
throughout their labors. Given all this, why
would any woman choose not to accept JV antibiotics?
But no woman can make a truly informed decision
about this issue without taking a critical
look at any recommendation that a third of
all women and their infants be given antibiotics
GBS is a bacterium that normally
lives in the intestinal tracts of many healthy
people. A vaginal-rectal area colonized by
GBS should not be termed "infected"
any more than an intestinal tract colonized
by GBS would be. GBS is a problem only when
it is present in the genital area of a pregnant
woman during labor and delivery. When this
happens, there is a small risk that the bacteria
will be passed on to the newborn infant and
that she or he will become sick as a result.
Approximately 0.5 percent of women found to
have GBS bacteria in their genital areas at
35 to 37 weeks into their pregnancies and who
are not treated with antibiotics will go on
to deliver a baby who becomes ill from GBS.
We should not take lightly the
use of antibiotics for 200 women and their
babies to prevent only a single blood infection--however
serious that infection might be--especially
in this age of increasing resistance to antibiotics.
Concerns have arisen in several areas regarding
the use of antibiotics for so many laboring
women. One dilemma is that colonization of
the vaginal area by GBS is, at best, a poor
method of predicting whether a newborn will
develop a GBS infection. As mentioned, even
without any intervention during labor, fewer
than 1 percent of infants born to carriers
of GBS develop infections. (6,7)
Some studies have shown a decrease
in GBS infection in newborns whose mothers
accepted TV antibiotics during labor, but no
decrease in the incidence of death. (8,9) Still
other research has found that preventive use
of antibiotics is not always effective. (10)
In fact, one study found no decrease in GBS
infection of deaths among newborns whose mothers
were given IV antibiotics during labor. (11)
Perhaps the greatest area of
concern to medical researchers, as it should
be to us all, is the alarming increase in antibiotic-resistant
strains of bacteria. Antibiotic-resistant bacteria
can cause infections in newborns that are very
difficult to treat. Many large research studies
have found not only resistant strains of GBS
but also antibiotic-resistant strains of E.
coli and other bacteria caused by the use of
antibiotics in laboring women. (12-21) Some
strains of GBS have been found to be resistant
to treatment by all currently used forms of
While many studies have found
that giving antibiotics during labor, to women
who test positive for GBS decreases the rate
of GBS infection among newborns, research is
beginning to show that this benefit is being
outweighed by increases in other forms of infection.
One study, which looked at the rates of blood
infection among newborns over a six-year period,
found that the use of antibiotics during labor
reduced the instance of GBS infection in newborns
but increased the incidence of other forms
of blood infection. (23) The overall effect
was that the incidence of newborn blood infection
The increase in other forms of
blood infection among newborns is likely due
to bacteria made drug-resistant by the overuse
of antibiotics. Evidence shows that increased
use of antibiotics frequently leads to increasing
bacterial resistance. When a woman is given
antibiotics during labor to treat GBS, the
antibiotics cross the placenta and enter the
amniotic fluid. While the antibiotics may have
the desired effect of killing the GBS bacteria,
some GBS bacteria can survive and become difficult,
if it not impossible, to kill with traditionally
used antibiotics. Similarly, other bacteria
that may be present in the mother of infant,
such as E. coli, can become resistant to antibiotic
treatment. These bacteria may not have presented
a large risk of infection to the newborn until
they were exposed to antibiotics and made into
A study of 43 newborns with blood
infections caused by GBS and other bacteria
found that when the mothers of the ill newborns
had been given antibiotics during labor, 88
to 91 percent of the infants' infections were
resistant to antibiotics. It is unlikely to
be a coincidence that the drugs to which the
bacteria showed resistance were the same antibiotics
that had been administered during labor. (24)
For the newborns who had developed blood infections
without exposure to antibiotics during labor
and delivery, only 18 to 20 percent of their
infections were resistant to antibiotics.
E. coli, in particular, is becoming
an increasing cause of bacterial infection
in newborns as the use of antibiotics in labor
has increased. One study, which looked at causes
of newborn blood infections between 1991 and
1996, found that the incidence of infections
caused by GBS decreased during this time, but
that the incidence of infection caused by other
bacteria, especially E. coli, increased. (25)
During those years, antibiotic use during labor
increased from less than 10 percent to almost
17 percent of the women included in this study.
The researchers concluded that increased use
of antibiotics during labor was the likely
cause of increased newborn blood infections
with bacteria other than GBS.
E. coli infection is particularly
difficult to treat in premature babies. Unfortunately,
the proportion of E. coli bacteria that are
resistant to antibiotic treatment has increased
astronomically in premature infants in the
past few years. In a review of 70 cases of
E. coli infection in newborns over a two-year
period, researchers found that 29 percent of
the E. coli bacteria present in premature babies
were resistant to ampicillin in 1998; two years
later, 84 percent of the E. coli bacteria present
in premature babies were resistant to the same
Preterm labor (labor before 37
weeks) is a well-accepted risk factor for transmission
of GBS to the infant during labor and delivery.
Due to the larger risk of transmitting GBS
to a premature baby during delivery, most women
who go into early labor will opt to receive
IV antibiotics during labor. However, infants
born prematurely are at a greater risk from
superbugs caused by the very antibiotics that
are supposed to be reducing their risk of infection.
Severe complications for the babies, even deaths,
have occurred when women whose waters broke
before 37 weeks were given antibiotics to prevent
transmission of GBS to their newborns. St.
Joseph's Hospital in Denver, Colorado, tracked
four cases in which women whose waters broke
before 37 weeks were given ampicillin or amoxicillin.
Following the administration of antibiotics,
infection of the amniotic fluid occurred in
all four cases. Two of the infants died as
a result of blood infections from resistant
bacteria; a third was stillborn, presumably
from the same cause. (27)
Given the frightening results
of these studies, what is a woman to do if
she tests positive for GBS during her pregnancy?
A closer look at the real risks of transmission,
a frank talk with her provider of prenatal
care, and a consideration of alternatives for
eradicating GBS are all good places to start.
How great is the risk of my baby
becoming sick from GBS?
There ate three significant factors
that place a woman at increased risk of delivering
ah infant who becomes ill from GBS: fever during
labor, her water breaking 18 hours of more
before delivery (prolonged rupture of membranes,
or PROM), and/or labor or broken water before
37 weeks gestation. (28) Other factors that
can contribute to a newborn's risk of contracting
GBS infection include age, ethnicity, and medical
criteria, such as the following: being born
to a mother who is less than 20 years old,
(29, 30) being African American, (31, 32) the
mother having large amounts of GBS bacteria
in her vaginal tract, (33-37) and being born
to a mother who has given birth to a prior
sibling with GBS disease. (38-40)
In the absence of the first three
risk factors (fever during labor, PROM, or
labor before 37 weeks), the risk of a newborn
developing GBS infection is very small: The
CDC estimates that, without the use of antibiotics
during labor, only one out of every 200 GBS-positive
women without these risk factors (0.5 percent)
will deliver an infant with GBS disease. Some
studies have found even lower rates of transmission.
If antibiotics are given to the mother during
labor, the CDC estimates that one in 4,000
GBS-positive women with no other risk factors
will deliver an infant with GBS infection.
Conservative studies find that
the use of antibiotics during labor fails to
prevent up to 30 percent of GBS infections
and 10 percent of deaths from GBS disease or
infections. (41, 42) Although, by CDC estimations,
there is a reduced risk of GBS transmission
with the use of antibiotics, one must take
into account the risks posed by the use of
the antibiotics themselves.
For a woman who has a negative
culture for GBS at 35 to 37 weeks, there is
a one in 2,000 risk of her newborn developing
a GBS infection, and antibiotics are not recommended
by the CDC. The CDC does recommend treating
with antibiotics all women with risk factors
(fever, PROM, premature labor) if they have
not been tested to determine whether they are
carriers of GBS.
What are the symptoms of GBS
infection in a baby?
There are two forms of GBS infection:
early and late onset. In early-onset GBS disease,
the infant will become ill within seven days
of birth. Of those infants who do develop a
severe early-onset GBS infection, approximately
6 percent will die from complications of the
infection. (43) Full-term babies are less likely
to die; 2 to 8 percent of them suffer fatal
complications. (44) Premature infants have
mortality rates of 25 to 30 percent. (45) Late-onset
GBS infection is more complex and has not been
convincingly tied to the GBS status of the
mother. Late-onset GBS infection occurs between
seven days and three months of age.
In newborns, symptoms of early-onset
GBS infection can include any of the following:
fever or abnormally low body temperature, jaundice
(yellowing of the skin and whites of the eyes),
poor feeding, vomiting, seizures, difficulty
in breathing, swelling of the abdomen, and
bloody stools. Of course, any of the above
symptoms can also be a sign of a sick newborn
who does not have a bacterial infection. Newborns
with any of these symptoms should be immediately
evaluated by a medical professional.
How great is the risk from antibiotics?
The recommended antibiotic for
treating GBS during labor is penicillin. Fewer
bacteria currently show a resistance to penicillin
than to other antibiotics used to treat GBS.
The options are fewer for women known to be
allergic to penicillin. Up to 29 percent of
GBS strains have been shown to be resistant
to non-penicillin antibiotics. (46) For women
not known to be allergic to penicillin, there
is a one in ten risk of a mild allergic reaction
to penicillin, such as a rash. Even for those
women who have no prior experience of a penicillin
allergy, there is a one in 10,000 chance of
developing anaphylaxis, a life-threatening
We can compare these statistics
to CDC estimates that 0.5 percent of babies
born to GBS-positive mothers with no treatment
will develop a GBS infection, and that 6 percent
of those who develop a GBS infection will die.
Six percent of 0.5 percent means that three
out of every 10,000 babies born to GBS-positive
mothers given no antibiotics during labor will
die from GBS infection. If the mother develops
anaphylaxis during labor (one in 10,000 will),
and it is untreated, it is likely that the
infant, too, will die. So, by CDC estimates,
we save the lives of two in 10,000 babies--0.02
percent--by administering antibiotics during
labor to one-third of all laboring women. We
should also keep in mind that this figure does
not take into account the infants who will
the as a result of bacteria made antibiotic-resistant
by the use of antibiotics during labor--Infants
who would not otherwise have become ill. When
you take that into account, there may not be
any lives saved by using antibiotics during
It should be noted, however,
that antibiotics such as penicillin do kill
GBS as well as other bacteria that might cause
a newborn to become ill. The benefits of using
penicillin during labor must be weighed against
your individual risk factors for passing GBS
on to your baby. It was only a few years ago
that the same could have been said about other
antibiotics. Ampicillin and amoxicillin have
been rendered virtually useless for treating
GBS by their prior overuse in laboring women
in an effort to prevent GBS infection in newborns.
How long will it be before penicillin, too,
becomes useless in the battle to prevent GBS
More minor risks of the use of
antibiotics include an increase in thrush and
other yeast infections among newborns. Along
with the risks of thrush and allergic reactions,
women must take into consideration the risk
of creating antibiotic resistant bacteria in
themselves and their newborns. It is possible
that exposure to antibiotics during birth could
delay establishment of healthy bacteria in
an infant's intestinal tract and allow penicillin
resistant bacteria, many of which are harmful,
to become established.
Each woman must weigh for herself
the likelihood of GBS infection in her newborn,
taking into account her individual risk factors
as well as the risk of other forms of infection
caused by antibiotic-resistant bacteria. This
is a good discussion to have with your healthcare
provider so that you can be an informed partner
in your own health care.
Are there alternatives to antibiotics?
Many women are interested in
alternatives to antibiotics that may help get
rid of GBS prior to labor. Unfortunately, no
scientific studies of alternative treatments
have been published. Several researchers have
suggested that studies are needed Io determine
whether alternative approaches to eradicating
GBS in pregnant women would be effective. Alternate
approaches that have been suggested include
vaginal washing and immunotherapy. (47) At
this point, however, these alternatives remain
to be studied, and I am aware of no healthcare
providers who use either method.
Some practitioners of natural
medicine have suggested supplements for the
mother in an effort to eradicate GBS prior
to delivery. One suggestion is that when a
woman tests positive for GBS, she should take
a course of garlic, vitamin C, echinacea, and/or
bee propolis, and then be retested to determine
if she is still carrying GBS. Any supplements
that a pregnant woman considers taking should
first be discussed with a homeopathic or naturopathic
physician or other knowledgeable practitioner
of natural medicine.
Because colonization by GBS is
intermittent or transient for 60 percent of
carriers, testing positive for GBS once does
not indicate that a woman will always be colonized.
(48) However, most studies indicate that a
positive culture at 35 to 37 weeks gestation
is a fairly accurate predictor of GBS colonization
at delivery. Without an active effort to eradicate
the GBS colonization, it is likely that a woman
will still be colonized at delivery.
Ultimately, it is the pregnant
woman herself who will have to decide what
is right for her and her baby. Deciding to
follow the recommendations of ACOG and the
CDC is not necessarily the wrong choice, as
long as a woman is adequately informed of the
risks that come with antibiotic use. But none
of us should blindly follow recommendations
to interfere with the natural birth process
without taking a good look at the risks, as
well as the benefits, of doing so.
Ideally, you will begin treatment
at about 32 weeks, on confirmation of the presence
of GBS in a vaginal culture, a urine sample,
or a rectal sample. (Some doctors will do both
a vaginal and a rectal swab.) Treatment will
include orally taking herbs that strengthen
your immune system and vaginally applying herbs
that will restore your healthy vaginal flora,
enable your body to reduce bacterial over-growth,
and directly fight the bacteria. As you enter
the last few weeks of pregnancy, from 37 weeks
onward (since your baby is unlikely to be premature),
most midwives will be willing to assist you
at home if this is your plan. in the hospital,
your baby will also be considered close to
full term and will not be treated as premature
in most circumstances, At 37 weeks, you can
therefore begin to use certain herbs, both
orally and vaginally, that are sometimes considered
labor stimulants but are nonetheless effective
for reducing bacterial infections.
At 32 weeks, begin to take a
supplement of 500 mg of vitamin C and one cup
of burdock root and echinacea root infusion.
To prepare the infusion, steep one-half ounce
of each of these herbs in four cups of boiling
water for two hours. Strain and take the above
dose, storing the rest in the refrigerator
for the next day.
Eat a lot of fresh garlic every
Take one-half teaspoon each of
echinacea and astragalus tinctures twice daily.
You can also get dried astragalus in the herb
department of your health food store, and cook
two strips into a pot of rice or soup two to
three times per week Remove the strips when
done cooking and eat the rice or soup. Astragalus
is an immune system tonic, well known in the
Chinese pharmacopoeia but also found in America
* Chop a clove of fresh garlic
and mix with a teaspoon of honey. Swallow this
mixture without chewing it. Repeat several
times a day, preferably with a meal.
* Make a garlic elixir by blending
one-half cup of honey, one quarter cup of apple
cider vinegar, and half a bulb of fresh garlic
in your blender until liquified. Take one-half
teaspoon up to twice a day. Adjust the taste
as necessary with more or less honey or vinegar.
* Chop fresh garlic onto a salad
or mix with olive oil to use as a dressing
or a dip for French bread.
* Take garlic perles according
to the dosage on he brand you purchase.
Excerpted from The Natural Pregnancy Book,
by Aviva Jill Romm, copyright [c]2003. Reprinted
by permission of Celestial Arts. Available
at bookstores everywhere
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(9.) D. A. Terreno et al., "Neonatal Sepsis
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(12.) See Note 9.
(13.) E. M. Levine et al., "Intrapartum
Antibiotic Prophylaxis Increases the Incidence
of Gram Negative Neonatal Sepsis," Infectious
Disease Obstetric Gynecology 7, no. 4 (1999):
(14.) C. V. Towers and G. G. Briggs, "Antepartum
Use of Antibiotics and Early-Onset Neonatal
Sepsis: The Next Four Years," American
Journal of Obstetric Gynecology 187, no. 2
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(21.) S. D. Manning et al., "Correlates
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(22.) See Note 19.
(23.) See Note 13.
(24.) See Note 14.
(25.) See Note 15.
(26.) See Note 17.
(27.) See Note 16.
(28.) K. M. Boyer and S. P. Gotoff, "Strategies
for Chemoprophylaxis of GBS Early-Onset Infections,"
Antibiotic Chemotherapy 35 (1985): 267-289.
(29.) A. Schuchat et al., "Population-Based
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Atlanta," Journal of Infectious Disease
162 (1990): 672-677.
(30.) A, Schuchat et al., "Multistate
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for Neonatal Group B Streptococcal Disease,"
Pediatric Infectious Disease Journal 13 (1994):
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(32.) K. M. Zangwill et al., "Group B
Streptococcal Disease in the United States,
1990: Report from a Multistate Active Surveillance
System," in CDC Surveillance Summaries
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(33.) M. A. Pass et al, "Prospective Studies
of Group B Streptococcal Infections in Infants,"
Journal of Pediatrics 95 (1979): 431-443
(34.) E. G. Wood and H. C. Dillon, "A
Prospective Study of Group B Streptococcal
Bacteriuria in Pregnancy," American Journal
of Obstetrics and Gynecology 140(1981): 515-520.
(35.) M. Moller et al., "Rupture of Fetal
Membranes and Premature Delivery Associated
with Group B Streptococci in Urine of Pregnant
Women," Lancet 2, no. 8394(14 July 1984):
(36.) T. E. Liston et al., "Relationship
of Neonatal Pneumonia to Maternal Urinary and
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South Medical Journal 72 (1979): 1410-1412
(37.) K. Persson et al., "Asymptomatic
Bacteriuria during Pregnancy with Special Reference
to Group B Streptococci," Scandinavian
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(38.) H. Carstensen et al., "Early-Onset
Neonatal Group B Streptococcal Septicaemia
in Siblings," Journal of Infection 17(1988):
(39.) G. Faxelius et al., "Neonatal Septicemia
due to Group B Streptococci: Perinatal Risk
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(40.) K. K. Christensen et al., "Obstetrical
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(41.) See Note 18.
(42.) K. M Boyer and S. R Gotoff, "Prevention
of Early-Onset Neonatal Group B Streptococcal
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(43.) See Note 32.
(44.) Committee on Infectious Diseases and
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for Prevention of Group B Streptococcal (GBS)
Infection by Chemoprophylaxis," Pediatrics
90 (1992): 775-778.
(46.) See Notes 18, 20, 21.
(47.) See Notes 14, 15.
(48.) B. F. Anthony et al., "Genital and
Intestinal Carriage of Group B Streptococci
during Pregnancy, "Journal of Infectious
Disease 143 (1981): 761-766.
Christa Novelli has a master's
degree in public health. She lives in Colorado
with her husband and two daughters, Angelina
(5) and Tessa (3). Christa tested positive
for group B strep with her second pregnancy
and opted not to take IV antibiotics. Tessa
did not develop a GBS infection.
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