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Meta-Analysis
. 2017 Nov 6;65(suppl_2):S112-S124.
doi: 10.1093/cid/cix660.

Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

Jennifer Hall  1 , Nadine Hack Adams  2 , Linda Bartlett  3 , Anna C Seale  4   5 , Theresa Lamagni  6 , Fiorella Bianchi-Jassir  4 , Joy E Lawn  4 , Carol J Baker  7 , Clare Cutland  8 , Paul T Heath  9 , Margaret Ip  10 , Kirsty Le Doare  9   11 , Shabir A Madhi  12   13 , Craig E Rubens  14   15 , Samir K Saha  16 , Stephanie Schrag  17 , Ajoke Sobanjo-Ter Meulen  18 , Johan Vekemans  19 , Michael G Gravett  14   20
Affiliations
Meta-Analysis

Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

Jennifer Hall et al. Clin Infect Dis. .

Abstract

Background: Infections such as group B Streptococcus (GBS) are an important cause of maternal sepsis, yet limited data on epidemiology exist. This article, the third of 11, estimates the incidence of maternal GBS disease worldwide.

Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on invasive GBS disease in women pregnant or within 42 days postpartum. We undertook meta-analyses to derive pooled estimates of the incidence of maternal GBS disease. We examined maternal and perinatal outcomes and GBS serotypes.

Results: Fifteen studies and 1 unpublished dataset were identified, all from United Nations-defined developed regions. From a single study with pregnancies as the denominator, the incidence of maternal GBS disease was 0.38 (95% confidence interval [CI], .28-.48) per 1000 pregnancies. From 3 studies reporting cases by the number of maternities (pregnancies resulting in live/still birth), the incidence was 0.23 (95% CI, .09-.37). Five studies reported serotypes, with Ia being the most common (31%). Most maternal GBS disease was detected at or after delivery.

Conclusions: Incidence data on maternal GBS disease in developing regions are lacking. In developed regions the incidence is low, as are the sequelae for the mother, but the risk to the fetus and newborn is substantial. The timing of GBS disease suggests that a maternal vaccine given in the late second or early third trimester of pregnancy would prevent most maternal cases.

Keywords: group B Streptococcus; incidence; postpartum; pregnancy; serotype.

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Figures

Figure 1.
Figure 1.
Maternal group B streptococcal (GBS) disease in disease schema for GBS, as described by Lawn et al [28]. Abbreviations: GBS, group B Streptococcus; NE, neonatal encephalopathy.
Figure 2.
Figure 2.
Data search and included studies for maternal group B streptococcal disease.
Figure 3.
Figure 3.
Geographic distribution of data on maternal group B streptococcal (GBS) disease that met inclusion criteria.
Figure 4.
Figure 4.
Meta-analysis of the incidence of maternal group B streptococcal disease, split by denominator of women delivering (4 studies, N = 1576138) or total pregnancies (1 study, n = 150043). Abbreviations: CI, confidence interval; ES, effect size; GBS, group B Streptococcus.
Figure 5.
Figure 5.
Meta-analysis of the incidence of maternal GBS disease, split by severe sepsis (1 study, n = 799003) or sepsis (3 studies, N = 777135). Abbreviations: CI, confidence interval; ES, effect size; GBS, group B Streptococcus.
Figure 6.
Figure 6.
Group B Streptococcus (GBS) serotypes causing maternal GBS disease (5 studies, N = 310). Serotypes included in a pentavalent vaccine are shown in blue shades.
See this image and copyright information in PMC

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MeSH terms