Geographic Distribution of Maternal Group B Streptococcus Colonization and Infant Death During Birth Hospitalization: Eastern Wisconsin

Journal of Patient-Centered Research and Reviews, Apr 2016

Purpose Maternal group B Streptococcus (GBS) can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization. Methods We retrospectively studied mothers with live birth(s) in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed. Results Study population (N = 99,305) had a mean age of 28.1 years and prepregnancy body mass index (BMI) of 26.7 kg/m2; 64.0% were white, 59.2% married, 39.3% nulliparous and 25.7% cesarean delivery. Mean gestational age was 39.0 weeks. Rate of maternal GBS colonization (22.3% overall) was greater in blacks (34.1% vs. 20.1% in whites, P < 0.0001), unmarried women (25.5% vs. 20.0% married, P < 0.0001), women with sexually transmitted or other genital infections (P < 0.0001) and residents of ZIP code group 532XX (P < 0.0001), and was associated with increasing BMI (P < 0.0001). All predictors of colonization were significant on multivariable analysis. Rate of infant death was 5.7 deaths/1,000 live births (n = 558 excluding lethal anomalies and stillbirths) and was negatively associated with maternal GBS colonization (P < 0.0001). On multivariable analysis, 532XX ZIP code group, lower gestational age, preterm labor, hyaline membrane disease, normal spontaneous vaginal delivery, hydramnios, oligohydramnios and absence of maternal GBS were associated with infant death. Conclusions Geographic characteristics were associated with infant death and maternal GBS colonization. Further research is needed to determine if increased surveillance or treatment of mothers colonized with GBS decreases the risk of infant demise at birth.

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Geographic Distribution of Maternal Group B Streptococcus Colonization and Infant Death During Birth Hospitalization: Eastern Wisconsin

JPCRR • Geographic Distribution of Maternal Group B Streptococcus Colonization and Infant Death During Birth Hospitalization: Eastern Wisconsin Jessica J. F. Kram 0 Melissa A. Lemke 0 Community Health 0 Preventive Medicine Commons 0 Female Urogenital Diseases 0 Pregnancy 0 Dennis J. Baumgardner 0 Part of the Bacterial Infections and Mycoses Commons, Clinical Epidemiology Commons Complications Commons, and the Infectious Disease Commons Recommended Citation Kram JJ, Baumgardner DJ, Vander Wyst KB, Lemke MA. Geographic distribution of maternal group B Streptococcus colonization and infant death during birth hospitalization: eastern Wisconsin. J Patient Cent Res Rev. 2016;3:66-78. doi: 10.17294/2330-0698.1252 Follow this and additional works at; https; //aurora; org/jpcrr - Journal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations. Geographic Distribution of Maternal Group B Streptococcus Colonization and Infant Death During Birth Hospitalization: Eastern Wisconsin 1Center for Urban Population Health, Milwaukee, WI 2Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI 3Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI 4TRIUMPH Program, University of Wisconsin School of Medicine and Public Health, Madison, WI Purpose Methods Results Conclusions Maternal group B Streptococcus (GBS) can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization. We retrospectively studied mothers with live birth(s) in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed. Study population (N=99,305) had a mean age of 28.1 years and prepregnancy body mass index (BMI) of 26.7 kg/m2; 64.0% were white, 59.2% married, 39.3% nulliparous and 25.7% cesarean delivery. Mean gestational age was 39.0 weeks. Rate of maternal GBS colonization (22.3% overall) was greater in blacks (34.1% vs. 20.1% in whites, P<0.0001), unmarried women (25.5% vs. 20.0% married, P<0.0001), women with sexually transmitted or other genital infections (P<0.0001) and residents of ZIP code group 532XX (P<0.0001), and was associated with increasing BMI (P<0.0001). All predictors of colonization were significant on multivariable analysis. Rate of infant death was 5.7 deaths/1,000 live births (n=558 excluding lethal anomalies and stillbirths) and was negatively associated with maternal GBS colonization (P<0.0001). On multivariable analysis, 532XX ZIP code group, lower gestational age, preterm labor, hyaline membrane disease, normal spontaneous vaginal delivery, hydramnios, oligohydramnios and absence of maternal GBS were associated with infant death. Geographic characteristics were associated with infant death and maternal GBS colonization. Further research is needed to determine if increased surveillance or treatment of mothers colonized with GBS decreases the risk of infant demise at birth. (J Patient Cent Res Rev. 2016;3:66-78.) group B Streptococcus; infant death; pregnancy complications, infectious; infant, newborn disease Group B Streptococcus (GBS) infections are a leading cause of maternal and neonatal morbidity, often associated with pregnancy complications (e.g. endometritis) as well as maternal and neonatal infections (e.g. urinary tract infections and sepsis, Correspondence: Jessica J. F. Kram, MPH, Center for Urban Population Health, 1020 N. 12th Street, #4180, Milwaukee, WI, 53233, T: 414-219-5594, F: 414-219-6563, Email: respectively).1-3 GBS significantly contributes to numerous systemic and focal neonatal diseases during the first several weeks of life.1 Early-onset GBS occurs within the first week of life and frequently presents as sepsis, pneumonia or meningitis.1-3 Late-onset GBS occurs when the infant is at least 1 week old or up to 3 months old (most cases occur between 3 and 4 weeks of age) and commonly presents as occult bacteremia or meningitis.1,3 Both early-onset and late-onset GBS disease can be fatal.1,2 Perinatal GBS is usually transmitted to a newborn during a vaginal delivery from a colonized mother. Generally recognized risk factors for early-onset neonatal GBS disease include infant birth at less than 37 weeks, birth after membranes ruptured for more than 18 hours, high concentration of GBS bacterium in mother, previous infant with invasive GBS, limited prenatal care, maternal a (...truncated)


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Jessica J. F. Kram, Dennis J Baumgardner, Kiley B Vander Wyst, Melissa A Lemke. Geographic Distribution of Maternal Group B Streptococcus Colonization and Infant Death During Birth Hospitalization: Eastern Wisconsin, Journal of Patient-Centered Research and Reviews, 2016, Volume 3, Issue 2,