Preventing Group B Strep in Pregnancy
A common concern in the third trimester in pregnancy is Group B Strep (GBS).
This common bacteria is found in 10 – 35% of all healthy, adult women (in the vagina, rectum and urinary bladder). It's normally kept in check by the Lactobacillis strains, but can certainly overgrow.
While most women don't experience any symptoms associated with GBS, it can be passed to baby during birth. This may lead to some serious complications in newborns like primary neonatal sepsis (infection of the blood), pneumonia (infection of the lungs) and meningitis during (infection of the brain's lining and spinal tissue).
Risk factors for Group B Strep include:
African-American descent
Multiple sexual partners
Male-to-female oral sex
Frequent or recent sex
Tampon use
Infrequent hand-washing
Younger than 20 years old
History of vaginal infections
Previous GBS+ pregnancy
When does the Group B Strep swab happen?
A routine culture test is typically done around 35-37 weeks gestation. The rectum and vagina of the pregnant person are swabbed with a Q-tip, and then sent for culture.
What Happens If You are Group B Strep Positive?
If you are GBS positive, you'll be given antibiotics during labour, or if your membranes break early. Although there isn't a guarantee that you will transmit this bacteria to your baby, antibiotics are given to reduce this risk.
According to the SOGC, once you're tested at 35-37 weeks, you're not tested again.
Preventing Group B Strep
As I previously mentioned, the SOCG does not recommend re-testing pregnant people who tested positive for GBS at the time of birth (although your Midwife may do so). Therefore, we need to be proactive about this and improve the vaginal microbiome before the GBS swab is done.
The beginning of the third trimester is a great time to establish a foundation of healthy gut flora, boost immune function, and ensure that your diet is conducive to a healthy gut.
Women who have a history of UTIs and bladder infections or were GBS positive during a previous pregnancy, may benefit from seeking support early on in pregnancy (such as during the first trimester).
Naturopathic Support for GBS
First Pregnancy
At 32-33 weeks, I encourage pregnant clients to book an appointment to prepare their vaginal microbiome for the GBS swab. Most often probiotics and herbal immune support (like garlic and echinacea) are used to support a healthy vaginal microbiome.
Can Any Probiotic Be Used?
A 2016 study looked a how probiotics could affect vaginal flora after a woman has tested positive with GBS. Ninety-nine women were were all diagnosed by GBS culture as being GBS positive between 35 to 37 weeks. They were then split into two groups - treatment and placebo group. The treatment group took 2 oral probiotics capsules before bed (containing L. rhamnosus GR-1 and L. reuteri RC-14) until delivery, and the placebo group took 2 placebos before bed until delivery.
At time of delivery, the women were re-tested (vaginally and rectally) to determine if they were still GBS positive. In the probiotic group 42.9% in women were no longer GBS positive, whereas in the placebo group, only 18% were no longer GBS positive. This is obviously quite exciting as those two probiotic strains had a positive effect on the microbiome and reduced GBS colonization!
Second+ Pregnancy
If you tested GBS positive in prior pregnancies, I recommend booking an appointment at the beginning of the third trimester to support your vaginal microbiome. While I follow a similar protocol as above, a longer course of treatment is necessary to positively impact the vaginal flora.
Final Thoughts
If you have a history of GBS, bacterial vaginosis, UTI and/or yeast infections, and are hoping to improve your vaginal flora - book an appointment with me! We'll work together to get your bacteria back in line, and call an end to those vaginal infections.
Reference
Ho M, Chang Y, Chang W et al. Oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 to reduce Group B Streptococcus colonization in pregnant women: A randomized controlled trial. Taiwanese Journal of Obstetrics and Gynecology. 2016;55(4):515-518. doi:10.1016/j.tjog.2016.06.003.
Management of Group B Streptococcal Bacteriuria in Pregnancy
Note: This article only discusses research in preventing a GBS+ colonization prior to a GBS culture done by an OB/GYN or midwife. It purposefully does not discuss what to do in the case of a positive GBS+ test.