Global Effort to Prevent GBS in Newborns: WHO's New Screening and Prophylaxis Guidelines

The WHO recommends screening pregnant women for intrapartum antibiotic prophylaxis to prevent early-onset Group B Streptococcus disease in newborns, offering both universal and risk-based approaches depending on local healthcare resources. This guideline aims to reduce neonatal infections while emphasizing informed consent and the need for further research in low-resource settings.

The World Health Organization (WHO), in collaboration with several international institutes, including the University of Oxford, the Burnet Institute in Australia, and Sepsis Canada, has released a recommendation on screening pregnant women for intrapartum antibiotic prophylaxis (IAP) to prevent early-onset Group B Streptococcus (GBS) disease in newborns. This recommendation is based on a systematic review of evidence from high-income countries and offers guidance for healthcare professionals involved in maternal and newborn care. GBS, a bacterium that can be found in the gastrointestinal and genital tracts, affects over 390,000 newborns each year and is a leading cause of neonatal sepsis. Without preventive measures, GBS can be transmitted from mother to baby during labor, potentially causing severe complications such as sepsis, meningitis, or pneumonia. This new WHO guideline is designed to help identify women at risk of transmitting GBS to their newborns and provide effective antibiotic intervention.

Universal Screening vs. Risk-Based Approach

The WHO's recommendation provides two main strategies for preventing early-onset GBS disease: universal screening and a risk-based approach. Universal screening involves testing all pregnant women for GBS colonization during the later stages of pregnancy, typically between 35 and 37 weeks. Rectovaginal swabs are used to detect GBS, and women who test positive are offered antibiotics during labor to reduce the risk of transmitting the bacteria to their newborns. On the other hand, the risk-based approach focuses on identifying pregnant women who have specific risk factors associated with GBS transmission, such as maternal fever, premature rupture of membranes, or a history of GBS infection in a previous child. In this approach, women are not screened with swabs but are instead evaluated for these risk factors, and those who meet the criteria are given antibiotics during labor. The WHO emphasizes that either approach can be effective in reducing the incidence of GBS in newborns, but local healthcare systems must consider their specific contexts when deciding which strategy to implement.

Adapting Strategies for Different Regions

The guideline takes into account the fact that different regions face unique challenges in implementing such preventive measures. While universal screening has been shown to be more effective in reducing GBS transmission, it is also more costly and resource-intensive. High-income countries with well-established healthcare systems may find it easier to implement universal screening, but in low- and middle-income countries, where resources may be limited, a risk-based approach might be more feasible. The WHO acknowledges these challenges and encourages health ministries to adapt the recommendations to suit their local contexts. For instance, the infrastructure needed to perform routine testing, process laboratory cultures, and ensure the continuity of care for women who screen positive may not be readily available in all settings. In such cases, the risk-based approach could offer a more practical solution, as it requires fewer resources and can be integrated into existing maternal care protocols without the need for extensive laboratory support.

Ensuring Informed Consent and Patient Care

In addition to the logistical and financial considerations, the WHO recommendation highlights the importance of patient communication and consent. Women should be fully informed about the purpose of GBS screening, the procedure involved, and the potential implications of a positive result, including the use of antibiotics during labor. This is crucial not only for ensuring that women make informed decisions but also for managing anxiety related to the screening process. Healthcare providers must offer culturally sensitive and patient-centered care, ensuring that women understand their options and are able to give or withhold consent without fear of mistreatment. The WHO's emphasis on informed consent reflects its broader commitment to promoting respectful and ethical maternal care across all settings.

Potential Health Impacts of Antibiotics in Newborns

The recommendation also touches on the long-term effects of IAP on newborn health, a topic of ongoing research. While antibiotics are highly effective at preventing GBS transmission during labor, there is some concern about the potential impact of early antibiotic exposure on a newborn’s gut microbiome and future health. Studies have suggested that early antibiotic use could be linked to an increased risk of developing conditions like asthma or obesity later in life, though more research is needed to fully understand these potential risks. WHO acknowledges these concerns and stresses the importance of further studies to examine both the short- and long-term health outcomes of antibiotic use in this context. As such, the guideline leaves room for updates based on emerging evidence, particularly from low-resource settings and ongoing clinical trials investigating alternative approaches, such as rapid intrapartum testing for GBS.

Closing Research Gaps and Improving Outcomes

Furthermore, the WHO identifies gaps in the current research, particularly in understanding the effectiveness, feasibility, and cost-effectiveness of both universal and risk-based screening strategies in low- and middle-income countries. These regions, where healthcare systems may already be stretched, face additional challenges in implementing new screening protocols. The guideline underscores the need for more research to determine which screening methods are most suitable for these settings, with the ultimate goal of reducing neonatal morbidity and mortality due to GBS infection globally. The WHO also highlights the potential of rapid intrapartum testing as a future alternative to the current strategies, noting that such technology could offer a more timely and accurate method for identifying women at risk of transmitting GBS to their newborns.

The WHO’s recommendation on screening pregnant women for intrapartum antibiotic prophylaxis offers a flexible framework for preventing early-onset GBS disease in newborns. While universal screening is likely the most effective method in high-resource settings, the risk-based approach provides a viable alternative in regions where resources are limited. This recommendation emphasizes the importance of adapting strategies to local contexts, ensuring that all pregnant women have access to the care they need to protect their newborns from GBS-related complications. The guideline also calls for ongoing research to fill the gaps in understanding the broader implications of antibiotic use in newborns and to explore innovative approaches to screening and prevention. Through this global effort, WHO aims to reduce the burden of GBS disease and improve maternal and newborn health outcomes worldwide.