Risk of Early-Onset Neonatal Group B Streptococcal Disease with Maternal Colonization Worldwide: Systematic Review and Meta-analyses

Neal J. Russell, Anna C. Seale, Catherine O'Sullivan, Kirsty Le Doare, Paul T. Heath, Joy E. Lawn, Linda Bartlett, Clare Cutland, Michael Gravett, Margaret Ip, Shabir A. Madhi, Craig E. Rubens, Samir K. Saha, Stephanie Schrag, Ajoke Sobanjo-Ter Meulen, Johan Vekemans, Carol J. Baker

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Background. Early-onset group B streptococcal disease (EOGBS) occurs in neonates (days 0.6) born to pregnant women who are rectovaginally colonized with group B Streptococcus (GBS), but the risk of EOGBS from vertical transmission has not been systematically reviewed. This article, the seventh in a series on the burden of GBS disease, aims to estimate this risk and how it varies with coverage of intrapartum antibiotic prophylaxis (IAP), used to reduce the incidence of EOGBS. Methods. We conducted systematic 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Sciences Literature (LILACS), World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on maternal GBS colonization and neonatal outcomes. We included articles with.200 GBS colonized pregnant women that reported IAP coverage. We did meta-analyses to determine pooled estimates of risk of EOGBS, and examined the association in risk of EOGBS with IAP coverage. Results. We identified 30 articles including 20 328 GBS-colonized pregnant women for inclusion. The risk of EOGBS in settings without an IAP policy was 1.1% (95% confidence interval [CI],.6%.1.5%). As IAP increased, the risk of EOGBS decreased, with a linear association. Based on linear regression, the risk of EOGBS in settings with 80% IAP coverage was predicted to be 0.3% (95% CI, 0.9). Conclusions. The risk of EOGBS among GBS-colonized pregnant women, from this first systematic review, is consistent with previous estimates from single studies (1%.2%). Increasing IAP coverage was linearly associated with decreased risk of EOGBS disease.

Original languageEnglish (US)
Pages (from-to)S152-S159
JournalClinical Infectious Diseases
StatePublished - 2017


  • Streptococcus agalactiae
  • group B Streptococcus
  • neonatal sepsis.
  • risk
  • vertical transmission

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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