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
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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)