Colonization of Pregnant Women with Group B Streptococcus and Perinatal Outcomes in a Latin American Database Público

Abstract

Background: GBS is a primary cause of life-threatening bacterial infections in neonates and is prevented by screening pregnant women for GBS before delivery and intrapartum antibiotic treatment. However, there are limited data regarding national GBS screening practices and the epidemiology of maternal GBS colonization in Latin America.

Methods: We conducted a retrospective observational study using de-identified records of pregnant women from a regional database in five Latin American countries. A total of 444,972 records collected from January 1, 2009 through December 31, 2012 met study criteria and were included. These records were analyzed as follows: a) Maternal screening rates for GBS were determined; b) Association of demographic variables (ethnicity, age, education level, and civil status) with maternal screening for GBS was determined using logistic regression; c) Maternal GBS colonization prevalence was determined by year; d) Association of demographic variables with maternal GBS colonization was determined using logistic regression; e) Relative risk and confidence intervals were calculated to compare the risk of adverse perinatal outcomes among GBS positive versus GBS negative women; f) Binomial logistic regression was performed, adjusting for covariates associated with maternal GBS colonization, to assess if GBS remained independently associated with outcomes.

Results: Maternal GBS screening was less than 15% in each country, except Uruguay which screened greater than 65% of women. The final regression model examining maternal screening rates and demographic variables included the covariates ethnicity, maternal age group, education level and civil status. In Uruguay, GBS prevalence over the study period was 18.5%. Black women, older women and women without a primary education had higher rates of GBS colonization (21.3%, 20.4% and 21.9% respectively). Among Uruguayan women screened for GBS, maternal GBS colonization was associated with an increased relative risk of preterm birth and chorioamnionitis.

Conclusions: Our study highlights the need for national policy and investments to increase maternal GBS screening and better understand the prevalence of maternal GBS colonization in Latin America. Further research on the burden of neonatal GBS disease within Latin America is needed to inform the introduction of a maternal GBS vaccine, when available.

Table of Contents

Page

Distribution Agreement……………………………………………………………………………i

Approval Sheet……………………………………………………………………………………...ii

Abstract Cover Page……………………………………………………………………………....iii

Abstract………………………………………………………………………………………….......iv

Cover Page……………………………………………………………………………………….......v

Acknowledgments………………………………………………………………………………....vi

Table of Contents………………………………………………………………………………....vii

List of Tables……………………………………………………………………………………....viii

List of Figures…………………………………………………………………………………….....ix

CHAPTER                                                                                                                             

1              INTRODUCTION……………………………………………………………….............1

2              BACKGROUND………………………………………………………………….............3

           Microbiology and Pathogenesis of GBS………………………………….........3

Burden of GBS and Known Risk Factors…………………………………........4

Prevention Strategies…………………………………………………….............5

Latin America and the CLAP Database………………………………….........6

3              METHODS………………………………………………………………………............8

Aims……..…………………………………………………………..…..................8

Study Design………………………………………………………………8

Study Population…………………………………………………………..8

Measures……………………………………………………………….…....9

Sample Size and Power………………………………………………….10

Analytic Plan……………………………………………………………...11

4              RESULTS………………………………………………………………………..13

Aim 1…………………………………………………………………….....13

Aim 2…………………………………………………………………….....14

Aim 3…………………………………………………………………….....15

5              DISCUSSION…………………………………………………………………..17

6              CONCLUSIONS……………………………………………………………….22

7              REFERENCES………………………………………………………………….23

8              TABLES………………………………………………………………………….27

9              FIGURES………………………………………………………………………..32

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Epidemiology
Palabra Clave	Group B Streptococcus Latin America Maternal Health
Committee Chair / Thesis Advisor	Saad B. Omer, Yale University Lisa B. Haddad, Emory University
Committee Members	Matthew Magee, Emory University

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