Group B Streptococcus Colonization is Associated with Early Term Births Open Access

Mitchell, Kelsey Dorothy (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/v692t7109?locale=en
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Abstract

Group B Streptococcus Colonization is Associated with Early Term Births

OBJECTIVE: To document if maternal Group B Streptococcus (GBS) colonization
between 35 and 37 weeks of gestation is associated with increased early term birth
(between 37 and 39 weeks gestation).


METHODS: In this cohort study of women delivering at term at Centennial Women's
Hospital in Nashville, TN, GBS status and other clinical and demographic data were
obtained from medical records. Exposed women were those testing positive for GBS
(GBS positive [n=490]) and the unexposed tested negative for GBS (GBS negative
[n=1,127]). Students t-tests and logistic regression determined association between GBS
status and early term delivery. Breslow-day tests were used to assess heterogeneity across
race strata.


RESULTS: The average gestational age was reduced to 271.1 (95% CI 270.4, 271.1)
days for the exposed, GBS positive women compared to 274.7 (95% CI 274.4, 275.1) days
for unexposed, GBS negative women (p <0.0001). The adjusted odds of early term birth
was increased by 3 fold in the exposed (OR 3.28; 95% CI 2.60 - 4.15; p <0.0001).
The mean birth weight of GBS positive women was 3285.3 (95% CI 3242.6, 3327.9) grams
that was lower than the GBS negative women, 3373.8 (95% CI 3348.9, 3398.7) grams
(p = 0.0004).


CONCLUSION: Colonization with GBS may have detrimental effects to the term infant
through shortening of the gestational age contributing to infant morbidity and mortality
warranting appropriate intervention and monitoring of GBS status during pregnancy.

Table of Contents

Chapter I: Literature Review...............................1
Group B Streptococcus..........................................1
Early onset disease...............................................1
Late onset disease...............................................2
Risk factors for GBS..............................................3
Racial disparities in acquisition of GBS.......................4
Prevention and treatment during pregnancy...............5
Term Birth...........................................................9
Definition of terms.................................................9
Accuracy of gestational age determination...............10
Determinants of shortened gestational age...............11
Outcomes based on gestational age........................11
GBS as a possible determinant of gestational age.......14
Chapter II: Manuscript.......................................16
Title Page..........................................................16
Abstract............................................................18
Introduction.......................................................20
Materials and Methods..........................................22
Subject Recruitment.............................................22
Statistical Analysis...............................................24
Results...............................................................24
Discussion...........................................................26
Chapter III: Extended Conclusions
.......................31
Further Racial Disparity Discussion............................31
Strengths and Limitations.......................................33
Public Health Implications.......................................34
Future Directions..................................................36
References..........................................................38
Tables................................................................43

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