Abstract
Maternal colonization with group B Streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. However, it remains unclear whether treating all colonized women during labor exposes a large number of their neonates to possible adverse effects without benefit. We performed a meta-analysis to assess the effect of intrapartum antibiotic prophylaxis on neonatal adverse outcomes. We identified studies by searching several English and Chinese electronic databases and reviewing relevant articles. Data were pooled using fixed-effects or random-effects meta-analysis, and for each outcome both risk ratio (RR) and 95% confidence intervals (95% CIs) were calculated. Fourteen studies (2,051 pregnant women and 2,063 neonates) were included, comprising 13 randomized clinical trials and 1 cohort study. Antibiotic prophylaxis is associated with a significant reduced risk of all cause infections (RR = 0.28, 95% CI = 0.18–0.42), GBS infection (RR = 0.24, 95% CI = 0.13–0.44), early-onset GBS infection (RR = 0.24, 95% CI = 0.13–0.45), non-GBS infections (RR = 0.34, 95% CI = 0.20–0.59), and GBS colonization (RR = 0.10, 95% CI = 0.06–0.16). But no significant reduction was observed in late-onset GBS infection, mortality from early-onset GBS infection or from non-GBS infections. Notably, no significant differences were found between ampicillin and penicillin prevention for neonatal adverse outcomes. Our findings suggest that antibiotic prophylaxis is effective in reducing neonatal GBS colonization and infection.
Highlights
Group B Streptococcus (GBS) is a significant cause of neonatal sepsis and meningitis and of severe infections in pregnant women (Murayama et al, 2009)
This updated meta-analysis confirms that antibiotic prophylaxis appears to significantly reduce the risk of neonatal adverse outcomes, including all cause infections, GBS infection, early-onset GBS (EOGBS) infection, non-GBS infections, and GBS colonization
There are two types of interventions that may reduce the risk of neonatal GBS infection by vertical transmission, including for high-risk (PROM, chorioamnionitis and so on) and moderaterisk mothers
Summary
Group B Streptococcus (GBS) is a significant cause of neonatal sepsis and meningitis and of severe infections in pregnant women (Murayama et al, 2009). Antibiotic Prevention for GBS Colonization guidelines in the past 20 years (1996, 2002, and 2010) that recommend the use of a risk-based or screening-based approach to identify candidates for intrapartum antibiotic prophylaxis (IAP; Centers for Disease Control and Prevention (CDC), 1996; Schrag et al, 2002; Verani et al, 2010). We systematically identified RCT and cohort studies on the issue published up to April 2016, and carried out a metaanalysis to explore the potential effect of intrapartum antibiotics for maternal GBS colonization on neonatal adverse outcomes (including GBS colonization, infection, and mortality)
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