Strep infections are common bacterial conditions. While often mild, their presence during pregnancy warrants specific attention due to potential implications for both the pregnant individual and the developing baby. Understanding these infections helps expectant parents and healthcare providers navigate pregnancy with informed care.
Understanding Strep in Pregnancy: Group A and Group B
Two primary types of Streptococcus bacteria are relevant during pregnancy: Group A Streptococcus (GAS) and Group B Streptococcus (GBS). Group A Streptococcus is widely known for causing “strep throat” (pharyngitis) and various skin infections like impetigo or cellulitis. This bacterium can lead to more severe conditions, such as scarlet fever or toxic shock syndrome. While GAS infections can occur in pregnant individuals, concerns typically mirror those in the general population.
Group B Streptococcus, in contrast, often lives harmlessly in the gastrointestinal and genitourinary tracts of many healthy adults. It is estimated that GBS colonizes about 10% to 30% of pregnant individuals without causing symptoms. This asymptomatic colonization means a person can carry the bacteria without knowing it. The primary concern with GBS during pregnancy is the risk of transmission to the newborn during vaginal birth.
Potential Health Impacts on Mother and Baby
For the pregnant individual, Group B Streptococcus colonization can sometimes lead to complications, though less common than the risk to the baby. GBS has been associated with an increased risk of preterm labor and premature rupture of membranes. More serious, though less frequent, maternal infections include chorioamnionitis (an infection of the amniotic fluid and membranes) and postpartum infections like endometritis after delivery.
Group A Streptococcus infections, while generally less common causes of severe pregnancy complications than GBS, can still pose risks. If a pregnant individual develops a severe GAS infection, such as pneumonia or sepsis, it could lead to serious illness. Postpartum infections from GAS, though rare, can also be severe.
For the developing baby, the main concern regarding GBS is the potential for early-onset neonatal GBS disease if the bacteria are transmitted during birth. This disease can manifest as serious conditions like sepsis (a bloodstream infection), meningitis (an infection of the lining around the brain and spinal cord), or pneumonia (a lung infection). These conditions can be life-threatening for newborns, with symptoms often appearing within the first week of life. While less common, some studies suggest a potential link between maternal GAS infections and adverse outcomes like preterm birth or low birth weight, though neonatal GAS infections are much less frequent than GBS.
Diagnosis and Screening During Pregnancy
For Group A Streptococcus, diagnosis typically occurs when a pregnant person experiences symptoms like a sore throat, fever, or swollen tonsils. Healthcare providers usually perform a rapid strep test. If the rapid test is negative but strep is still suspected, a throat culture may be sent for confirmation, as it is more sensitive.
For Group B Streptococcus, routine screening is a standard part of prenatal care. This involves swabbing the vaginal and rectal areas, typically between 35 and 37 weeks of pregnancy. This timing identifies GBS colonization close to when labor might begin, allowing for appropriate preventive measures. GBS screening aims to detect if the bacteria are present, not an active infection, as GBS colonization is often asymptomatic.
Management and Treatment Strategies
Management of Group A Streptococcus infections during pregnancy involves antibiotics to treat the symptomatic illness. Pregnancy-safe antibiotics, such as penicillin or amoxicillin, are prescribed to resolve the infection and prevent complications. Completing the full course of antibiotics is important to ensure eradication and minimize recurrence. Prompt treatment helps alleviate symptoms and protects the health of both the pregnant individual and the baby.
For Group B Streptococcus, the primary treatment strategy focuses on preventing transmission to the newborn during labor and delivery. If a pregnant individual tests positive for GBS colonization, they typically receive intravenous (IV) antibiotics during labor. This approach, known as intrapartum antibiotic prophylaxis, aims to reduce GBS bacteria in the birth canal, significantly lowering the risk of the newborn acquiring the infection. Common antibiotics include penicillin or ampicillin.
GBS colonization is usually not treated with antibiotics before labor unless specific risk factors or symptoms are present. The goal of treatment during labor is to provide protection when the risk of transmission is highest. Adhering to the healthcare provider’s treatment plan and communicating any concerns or symptoms throughout pregnancy and labor are important for managing strep infections effectively.