UK GBS Testing – Why do we not test ALL pregnant women?

My last post if you read it was in regards to GBS (Group B Strep) Which a lot of women carry and can unknowingly pass onto their babies during childbirth. If GBS is passed onto the baby during childbirth then the consequences can be very severe resulting in Neonatal Sepsis a potentially fatal condition that kills 5% of all babies who contract GBS related Sepsis. Neonatal Sepsis in itself has a mortality rate of 55%!

“The history of neonatal sepsis related to early onset group B streptococcus (GBS) emerged in the early 1970s. The neonatal mortality rate was 55% for those neonates with invasive GBS disease. The first adopted guidelines by the medical community to prevent early onset GBS were developed in the 1990s. One year after implementation of the guidelines, the mortality rate dropped to approximately 5%. Despite the great accomplishments in reducing the mortality rate, GBS remains the number one cause of infant morbidity and mortality in the United States.”

So why are we not routinely testing all pregnant women for GBS in the UK? The USA has a rigid testing schedule for all pregnant women that includes GBS. Their schedule also tests for Gestational Diabetes, another on the list that we here in the UK do not routinely test for!

The NCT website has this to say in regards to routine testing for GBS:

“There is no UK national screening programme to find out whether pregnant women carry GBS. Currently, the evidence suggests that screening all women for GBS during pregnancy would not be beneficial overall. The reasons for this include that:

  1. Most babies born to women who carry the bacterium do not become infected.
  2. It is not clear whether screening all women during pregnancy to see if they carry GBS would do more good than harm.3 Identifying women who are GBS carriers in order to treat them all with antibiotics during labour would result in many thousands of women and babies being treated in order to prevent a very small number of serious infections.
  3. There are important concerns about using antibiotics on this scale given by this method. Around 150,000 women each year would receive the drugs during labour by an intravenous (IV) route, i.e. through a tube into a vein. Concerns include the possible effect on the newborn babies’ normal gut flora (healthy bacteria); the risk of allergic reaction among the women receiving the drug; growing resistance to antibiotics in the whole population; and the effects of further medicalising care during childbirth. Women receiving IV antibiotics during labour are usually not offered the choices of having a home birth; going to a midwife-led birth centre; or using a birth pool in any setting. Labour ward care is associated with high rates of interventions, including unplanned caesarean births. 
  4. In countries where a screening programme has been introduced, it is carried out at around 36-37 weeks of pregnancy. Women whose babies are born pre-term, i.e. before this stage, would therefore not normally have been offered the option of screening.”

Most babies do not become infected: Surely most is not good enough? If only 100 babies were to get infected in a year then there are 5 deaths (minimum) that could be prevented. Unfortunately there are more than 100 babies being infected each year within the UK. This statement comes direct from the NHS GBS information page: “It’s estimated that about 1 in 2,000 babies born in the UK and Ireland develops early-onset GBS infection. This means that every year in the UK (with 680,000 births a year) around 340 babies will develop early-onset GBS infection.” So if we base the mortality rate at 5%  then we have a minimum of 17 unnecessary deaths in the UK each year from GBS related Neonatal Sepsis. This is simply not good enough!

To make matters worse when I researched further I found this on the gbss.org.uk site:

“Early-onset GBS infection is characterised by the rapid development of respiratory distress (breathing problems) and/or septicaemia (blood poisoning). Early-onset GBS infection has a higher mortality rate than late-onset infection – approximately 15% of babies die.”

So now based on 340 babies developing ‘Early Onset GBS Infection’ which occurs in the first 48 hours of life there are an estimated 34 – 68 babies dying each year in the UK. We know that with IV antibiotics being given to the mother during labour that we can reduce the risk of a baby developing GBS by as much as 90%!!

This isn’t exactly rocket science 90% of 68 deaths per year could be saved by a simple GBS test when pregnant! That’s 61 lives per year! 61 families who need not be suffering with the grief of losing a child!

I struggle to understand why the UK does not introducing testing as standard for all pregnant women. It makes no sense. I looked on the NHS site to see what explanation they would give for the lack of testing here in the UK and this is what they say:

“Screening for GBS should not be offered to all pregnant women. This is because there is insufficient evidence to demonstrate that the benefits to be gained from screening all pregnant women and treating those carrying the organism with intravenous antibiotics during labour would outweigh the harms.”

90% of GBS infections could be prevented with IV antibiotics during labour! Is this not sufficient evidence? Clearly I am missing something!

The only explanation I can think of is that the dear old NHS is trying to save money. With 680,000 women birthing each year in the UK then the cost for this must be quite high, then if we add in the cost of antibiotics during labour then I would guess that they are saving several million pounds a year from not testing.

The only question I have for the NHS is this:

Can you really put a price on a child’s life?

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