Group A Streptococcus (GAS), commonly known as strep throat, is a bacterial infection causing pharyngitis, inflammation of the throat and tonsils. While generally a mild illness in the non-pregnant population, a bacterial infection during pregnancy warrants prompt attention due to the expectant mother’s unique physiological changes. An untreated GAS infection carries the risk of serious complications and systemic stress for the pregnant individual. A swift medical assessment and treatment are necessary to resolve the infection and maintain a healthy pregnancy.
Recognizing Strep During Pregnancy
Identifying a strep infection relies on recognizing specific symptoms that often differ from a common cold or viral illness. A sudden onset of a painful sore throat is a hallmark sign of strep throat. Individuals often experience fever and difficulty swallowing, which can be accompanied by red and swollen tonsils.
A characteristic finding is the presence of white patches, streaks of pus on the tonsils, or tiny red spots called petechiae on the roof of the mouth. Unlike a typical cold, a strep infection is usually not accompanied by a cough, runny nose, or hoarseness. Any pregnant individual with these symptoms should seek immediate medical evaluation.
Diagnosis is confirmed quickly by a healthcare provider using a rapid strep test, performed by swabbing the back of the throat. If the rapid test is negative but suspicion remains high, a throat culture is often performed to ensure accuracy. Only a medical professional can determine the presence of Group A Streptococcus and initiate appropriate management.
Potential Maternal Complications
If a Group A Strep infection is left untreated, the risk of systemic complications in the pregnant individual increases significantly. The infection can progress beyond the throat, potentially leading to invasive Group A Streptococcus disease. Pregnant and postpartum women face a twenty-fold higher rate of invasive GAS infection compared to non-pregnant women of similar age.
One potential complication is Acute Rheumatic Fever, a delayed inflammatory response that can cause permanent damage to the heart valves. Another serious complication is Post-Streptococcal Glomerulonephritis, a condition involving inflammation and damage to the kidneys. Timely antibiotic treatment is necessary to prevent these complications.
A severe, untreated infection can also lead to sepsis, a life-threatening complication where the body’s response damages its own tissues and organs. The increased susceptibility to invasive disease in the perinatal period underscores the importance of quickly eradicating the bacterial presence.
Fetal and Neonatal Concerns
The primary risk to the developing baby is usually not the bacteria itself, but the secondary effects of a severe maternal infection. A high maternal fever, especially if sustained during the first trimester, is a concern because it has been associated with an increased chance of certain birth defects.
A severe systemic infection can also place significant stress on the pregnancy, potentially increasing the risk of obstetrical complications like preterm labor or premature rupture of membranes. Preterm birth (delivery before 37 weeks of gestation) can lead to various health issues for the newborn.
In rare instances, Group A Streptococcus can be vertically transmitted, causing neonatal sepsis, a bloodstream infection. This risk is most significant if the mother develops an invasive infection around the time of delivery or in the immediate postpartum period. It is important to distinguish this from Group B Streptococcus (GBS), a different bacterium routinely screened for in late pregnancy. The potential for systemic maternal illness to affect the pregnancy is the main concern that drives immediate intervention.
Pregnancy-Safe Treatment Protocols
Treating a strep throat infection in pregnancy requires antibiotics to eliminate the bacteria and prevent associated complications. The primary consideration is choosing an antibiotic that is effective against Group A Strep and safe for the developing fetus.
Penicillin V and amoxicillin are the preferred first-line treatment options because of their narrow spectrum of activity and long history of safety in pregnancy. For individuals with a documented penicillin allergy, alternative antibiotics are available depending on the severity of the allergic reaction.
A first-generation cephalosporin, such as cephalexin, is often the preferred alternative for those with a non-severe penicillin allergy. If the allergy is severe, macrolides like erythromycin or clindamycin may be used, guided by the specific pregnancy stage and the patient’s history. The full course of antibiotics, typically lasting ten days, must be completed as prescribed, even if symptoms improve quickly. Completing the entire course ensures bacterial eradication, preventing recurrence and minimizing post-streptococcal complications.