Group B Strep Support (GBSS), the charity for the UK's biggest cause of life-threatening infection in newborn babies, is urging the government to make sensitive testing for group B Streptococcus (GBS) available for all pregnant women, as recent research shows this would save money as well as babies' lives.
GBS is found naturally in around 25% of pregnant women and causes no ill effects to most babies and their mothers. However, without preventive medicine, around 700 babies in the UK contract GBS around the time of birth, presenting as septicaemia, meningitis, or pneumonia.
Of these, 75 will die, while another 40 suffer ongoing health problems, including deafness, blindness, cerebral palsy and severe learning difficulties. Antibiotics administered to the mother intravenously in labour are extremely effective at preventing GBS infections in newborn babies.
Currently, only a handful of UK hospitals offer pregnant women the sensitive test for GBS - the Enriched Culture Method (ECM) test - that involves taking a rectal and vaginal swab at 35-37 weeks of pregnancy. Most mothers-to-be are forced to rely on a postal test available through a small number of private laboratories.
Since 2003, the advice from the Royal College of Obstetricians and Gynaecologists has been to give antibiotics in labour to 'high-risk women', including those who have previously had a baby with GBS infection, who develop a GBS urinary infection during pregnancy, or who present with symptoms such as fever during labour.
However, recent figures show that this strategy has not lessened the number of newborn babies contracting GBS infection. Indeed, figures from the Health Protection Agency show that between 2003 and 2008, the number of babies contracting GBS infection in the UK in the first 90 days of life actually rose by over 50% - from 311 babies in 2003 to 470 in 2008. The 2009 figures confirm this increased number.
Now, new research published in BJOG – the International Journal of Obstetrics and Gynaecology suggests that the NHS could actually make significant cost savings by introducing ECM testing for all pregnant women at 35-37 weeks and offering antibiotics in labour accordingly.
The authors found that the cheapest preventive strategy would be to give antibiotics to all women in labour, but this would carry major disadvantages, such as medicalising childbirth and potentially increasing antibiotic resistance. Excluding this option, they found that "screening based on culture at 35-37 weeks' gestation, with antibiotics given to all those women who deliver prior to 35 weeks becomes the most cost-effective option."
They calculated that the risk factor approach currently used in the UK costs £50,000 per infection prevented, but that this would fall to £45,000 if routine screening were introduced (screening is more efficient because it prevents more cases). This is a purely financial advantage, without taking into account the savings from fewer babies needing intensive care, and without considering the distress to parents who lose their baby when this could easily have been prevented.
Group B Strep Support, which has been campaigning for enriched culture testing for approaching 10 years, welcomed the report's findings. Chief Executive Jane Plumb, who lost her newborn son to GBS infection, says, "It's been obvious for some time that the Royal College of Obstetricians and Gynaecologists' risk-based guidelines are less effective than routine testing in the number of babies saved and disability prevented.
Now there is new evidence that using the guidelines costs the NHS more than routine testing, so what better time to bring in ECM testing across the board? It is surely time for the Government to start thinking with its head as well as its heart."
Another issue with the current policy is that, because tests are not offered as standard, most women do not find out about GBS through their healthcare provider. A recent survey by Bounty Parenting Club found that 42% of women who are aware of GBS got information on GBS from a pregnancy book or magazine while 21% were told about it by a friend or another mum.
Just 20% were informed by a midwife, 4% through their family doctor and 2% from a clinic at hospital. This means that even when women are willing and able to pay for a private test, they are being denied that option by not knowing about it.
Professor Philip Steer, Chairman of the GBSS Medical Advisory Committee, says, "Proposals for high quality trials of screening in the UK have been turned down because of lack of funding. In the meantime, other countries such as the USA, Australia, Spain, Italy and Germany have all introduced screening and seen major falls in the incidence of this deadly disease – in the USA by 70% since screening was introduced. I can see no reason why screening would not be equally effective in the UK and we now know it would save money as well as lives."
Your comments (terms and conditions apply):
"Would there be any risk to the unborn baby of taking these extra swabs at 37 wks gestation? Is the postal method less reliable?" - Kate Salmon, Wychall Lane Surgery
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