Preterm Birth Associated with Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses

Fiorella Bianchi-Jassir, Anna C. Seale, Maya Kohli-Lynch, Joy E. Lawn, Carol J. Baker, Linda Bartlett, Clare Cutland, Michael G. Gravett, Paul T. Heath, Margaret Ip, Kirsty Le Doare, Shabir A. Madhi, Samir K. Saha, Stephanie Schrag, Ajoke Sobanjo-Ter Meulen, Johan Vekemans, Craig E. Rubens

Research output: Contribution to journalReview articlepeer-review

54 Scopus citations


Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS. Methods. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (<37 weeks' gestation) and maternal GBS colonization (GBS isolation from vaginal, cervical, and/or rectal swabs; with separate subanalysis on GBS bacteriuria). We did meta-analyses to derive pooled estimates of the risk and odds ratios (according to study design), with sensitivity analyses to investigate potential biases. Results. We identified 45 studies for inclusion. We estimated the risk ratio (RR) for preterm birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI],.99-1.48; P =.061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24-2.77; P =.003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45-2.69]; P <.001). Conclusions. From this review, there is evidence to suggest that preterm birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials.

Original languageEnglish (US)
Pages (from-to)S133-S142
JournalClinical Infectious Diseases
StatePublished - 2017


  • bacteriuria
  • colonization
  • group B Streptococcus
  • preterm delivery
  • preterm labor

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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