Department of Obstetrics and Gynecology, Faculty of Medicine, University Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, 50603, Malaysia.
BMC Pregnancy Childbirth. 2024 Jul 4;24(1):461. doi: 10.1186/s12884-024-06616-7.
Maternal Group B Streptococcus (GBS) colonization is influenced by many factors but results are inconsistent. Consideration of antenatal risk factors may help inform decision making on GBS microbiological culture screening where universal screening is not standard of care. We sought to identify independent predictors of GBS colonization at 34-37 weeks gestation incorporating vaginal symptoms, perineal hygiene measures, sexual activity, and a potential novel factor, constipation.
In this prospective cross-sectional study, 573 women at 34-37 weeks gestation had an ano-vaginal swab taken and sent for selective culture for GBS. Women were asked about vaginal bleeding, discharge, irritation and candidiasis, antibiotic use during pregnancy, ano-vaginal hygiene practices such as douching and perineal cleansing after toileting, sexual intercourse related activities, and a potential novel factor for GBS carriage, constipation. Maternal basic demographics and obstetric-related characteristics were also collected. Bivariate analyses were performed to identify associates of GBS colonization. All variables with p < 0.05 found on bivariate analysis were then included into a model for multivariable binary logistic regression analysis to identify independent risk factors for GBS colonization.
GBS colonization was found in 235/573 (41.0%) of participants. Twenty six independent variables were considered for bivariate analysis. Eight were found to have p < 0.05. Following adjusted analysis, six independent predictors of GBS colonization were identified: ethnicity, previous neonatal GBS prophylaxis, antenatal vaginal irritation, antibiotic use, recent panty liner use, and frequency of sexual intercourse. Vaginal discharge and perineal cleansing were not associated after adjustment. Recent douching and constipation were not associated on bivariate analysis.
The identification of independent predictors of GBS colonization in late pregnancy may inform the woman and care provider in their shared decision making for microbiological screening at 35-38 weeks gestation in locations where universal GBS screening is not standard of care.
This study was approved by the Medical Ethics Committee of University Malaya Medical Centre (UMMC) on August 9, 2022, reference number 2022328-11120.
母体 B 组链球菌（GBS）定植受多种因素影响，但结果不一致。考虑产前危险因素有助于在普遍筛查不是标准护理的情况下，为 GBS 微生物培养筛查提供决策依据。我们旨在确定纳入阴道症状、会阴卫生措施、性行为以及潜在的新因素——便秘的情况下，妊娠 34-37 周时 GBS 定植的独立预测因素。
在这项前瞻性横断面研究中，573 名妊娠 34-37 周的妇女进行了阴道肛门拭子采集，并进行选择性 GBS 培养。询问妇女阴道出血、分泌物、刺激和假丝酵母菌病、怀孕期间使用抗生素、阴道肛门卫生措施（如灌洗和排便后会阴清洁）、与性行为相关的活动以及潜在的 GBS 定植新因素——便秘。还收集了产妇基本人口统计学和产科相关特征。进行了单变量分析以确定 GBS 定植的相关因素。所有在单变量分析中 p 值<0.05 的变量随后被纳入多变量二项逻辑回归分析模型，以确定 GBS 定植的独立危险因素。
在 573 名参与者中，发现 235 名（41.0%）存在 GBS 定植。对 26 个独立变量进行了单变量分析。有 8 个变量发现 p 值<0.05。经过调整分析，确定了 6 个 GBS 定植的独立预测因素：种族、新生儿 GBS 预防前史、产前阴道刺激、抗生素使用、近期护垫使用和性交频率。调整后，阴道分泌物和会阴清洁与定植无关。近期灌洗和便秘在单变量分析中没有关联。
确定妊娠晚期 GBS 定植的独立预测因素可能有助于妇女和护理提供者在普遍筛查不是标准护理的情况下，共同决策在妊娠 35-38 周时进行微生物学筛查。
这项研究于 2022 年 8 月 9 日获得了马来西亚大学医学中心医学伦理委员会的批准，注册号为 2022328-11120。
