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Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses

BACKGROUND: Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a serie...

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Autores principales: Bianchi-Jassir, Fiorella, Seale, Anna C, Kohli-Lynch, Maya, Lawn, Joy E, Baker, Carol J, Bartlett, Linda, Cutland, Clare, Gravett, Michael G, Heath, Paul T, Ip, Margaret, Le Doare, Kirsty, Madhi, Shabir A, Saha, Samir K, Schrag, Stephanie, Sobanjo-ter Meulen, Ajoke, Vekemans, Johan, Rubens, Craig E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850429/
https://www.ncbi.nlm.nih.gov/pubmed/29117329
http://dx.doi.org/10.1093/cid/cix661
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author Bianchi-Jassir, Fiorella
Seale, Anna C
Kohli-Lynch, Maya
Lawn, Joy E
Baker, Carol J
Bartlett, Linda
Cutland, Clare
Gravett, Michael G
Heath, Paul T
Ip, Margaret
Le Doare, Kirsty
Madhi, Shabir A
Saha, Samir K
Schrag, Stephanie
Sobanjo-ter Meulen, Ajoke
Vekemans, Johan
Rubens, Craig E
author_facet Bianchi-Jassir, Fiorella
Seale, Anna C
Kohli-Lynch, Maya
Lawn, Joy E
Baker, Carol J
Bartlett, Linda
Cutland, Clare
Gravett, Michael G
Heath, Paul T
Ip, Margaret
Le Doare, Kirsty
Madhi, Shabir A
Saha, Samir K
Schrag, Stephanie
Sobanjo-ter Meulen, Ajoke
Vekemans, Johan
Rubens, Craig E
author_sort Bianchi-Jassir, Fiorella
collection PubMed
description BACKGROUND: Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS. 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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (<37 weeks’ gestation) and maternal GBS colonization (GBS isolation from vaginal, cervical, and/or rectal swabs; with separate subanalysis on GBS bacteriuria). We did meta-analyses to derive pooled estimates of the risk and odds ratios (according to study design), with sensitivity analyses to investigate potential biases. RESULTS: We identified 45 studies for inclusion. We estimated the risk ratio (RR) for preterm birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99–1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24–2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45–2.69]; P < .001). CONCLUSIONS: From this review, there is evidence to suggest that preterm birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials.
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spelling pubmed-58504292018-03-23 Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses Bianchi-Jassir, Fiorella Seale, Anna C Kohli-Lynch, Maya Lawn, Joy E Baker, Carol J Bartlett, Linda Cutland, Clare Gravett, Michael G Heath, Paul T Ip, Margaret Le Doare, Kirsty Madhi, Shabir A Saha, Samir K Schrag, Stephanie Sobanjo-ter Meulen, Ajoke Vekemans, Johan Rubens, Craig E Clin Infect Dis The Burden of Group B Streptococcus Worldwide for Pregnant Women, Stillbirths, and Children BACKGROUND: Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS. 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 from investigator groups on the association of preterm birth (<37 weeks’ gestation) and maternal GBS colonization (GBS isolation from vaginal, cervical, and/or rectal swabs; with separate subanalysis on GBS bacteriuria). We did meta-analyses to derive pooled estimates of the risk and odds ratios (according to study design), with sensitivity analyses to investigate potential biases. RESULTS: We identified 45 studies for inclusion. We estimated the risk ratio (RR) for preterm birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99–1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24–2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45–2.69]; P < .001). CONCLUSIONS: From this review, there is evidence to suggest that preterm birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials. Oxford University Press 2017-11-15 2017-11-06 /pmc/articles/PMC5850429/ /pubmed/29117329 http://dx.doi.org/10.1093/cid/cix661 Text en © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle The Burden of Group B Streptococcus Worldwide for Pregnant Women, Stillbirths, and Children
Bianchi-Jassir, Fiorella
Seale, Anna C
Kohli-Lynch, Maya
Lawn, Joy E
Baker, Carol J
Bartlett, Linda
Cutland, Clare
Gravett, Michael G
Heath, Paul T
Ip, Margaret
Le Doare, Kirsty
Madhi, Shabir A
Saha, Samir K
Schrag, Stephanie
Sobanjo-ter Meulen, Ajoke
Vekemans, Johan
Rubens, Craig E
Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses
title Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses
title_full Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses
title_fullStr Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses
title_full_unstemmed Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses
title_short Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses
title_sort preterm birth associated with group b streptococcus maternal colonization worldwide: systematic review and meta-analyses
topic The Burden of Group B Streptococcus Worldwide for Pregnant Women, Stillbirths, and Children
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850429/
https://www.ncbi.nlm.nih.gov/pubmed/29117329
http://dx.doi.org/10.1093/cid/cix661
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