Elena HogenEsch1, Bremen De Mucio2, Lisa B Haddad3, Alba Vilajeliu4, Alba Maria Ropero5, Inci Yildirim6, Saad B Omer7. 1. Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322, USA. Electronic address: elena.hogenesch@northwestern.edu. 2. Latin American Center for Perinatology/Panamerican Health Organization, Montevideo-Uruguay, Av. Brasil 2697, 1er piso, Montevideo 11600, Uruguay. Electronic address: demuciob@paho.org. 3. Emory University School of Medicine, Department of Obstetrics and Gynecology, Atlanta, GA, USA. Electronic address: lisa.haddad@emory.edu. 4. Comprehensive Family Immunization Unit, Family Health Promotion and Life Course Department, Pan American Health Organization (PAHO/WHO Regional Office for the Americas), 525 23rd Street NW, Washington, DC 20037, USA. Electronic address: vilajelmar@paho.org. 5. Comprehensive Family Immunization Unit, Family Health Promotion and Life Course Department, Pan American Health Organization (PAHO/WHO Regional Office for the Americas), 525 23rd Street NW, Washington, DC 20037, USA. Electronic address: roperoal@paho.org. 6. Emory University, Rollins School of Public Health, Depratment of Epidemiology, School of Medicine Division of Pediatric Infectious Disease, 2015 Uppergate Drive, Atlanta, GA, 30322, USA. Electronic address: inci.yildirim@emory.edu. 7. Yale Institute of Global Health, Department of Medicine (Section of Infectious Diseases), Yale School of Medicine. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 333 Cedar St, New Haven, CT 06510, USA. Electronic address: saad.omer@yale.edu.
Abstract
OBJECTIVE: To determine rates and results of maternal Group B streptococcus (GBS) screening during pregnancy and identify sociodemographic characteristics associated with GBS screening in Latin American countries. BACKGROUND: GBS is a primary cause of morbidity and mortality in neonates and is prevented by screening pregnant women for GBS before delivery and intrapartum antibiotic treatment. Yet, data regarding national GBS screening practices and the epidemiology of maternal GBS colonization in Latin America are limited. METHODS: We conducted a retrospective observational study using de-identified records of pregnant women in six Latin American countries from a regional database. 460,328 collected from January 1, 2009 through December 31, 2012 met study criteria and were included. Maternal screening rates for GBS were determined, association of demographic variables (ethnicity, age, education level, and civil status) with maternal GBS screening was determined using logistic regression, odds ratios were calculated comparing incidence of adverse neonatal outcomes (sepsis, pneumonia, and meningitis) between countries with high and low rates of GBS screening, maternal GBS colonization prevalence was determined by year and association of demographic variables with maternal GBS colonization was determined using logistic regression. RESULTS: Maternal GBS screening was less than 15% in each country, except Uruguay which screened greater than 65% of women. The final regression model examining maternal screening rates and demographic variables included the covariates ethnicity, maternal age group, education level and civil status. Countries with lower rates of maternal GBS screening had increased odds of neonatal sepsis [OR 23.3; 95% CI (15.2-35.9)] and pneumonia [OR 19.9; 95% CI (12.1-32.6)]. In Uruguay, GBS prevalence over the study period was 18.5%. Black women, older women and women without a primary education had higher rates of GBS colonization (21.3%, 20.4% and 21.9% respectively). CONCLUSIONS: Our study highlights the need for national policy and investments to increase maternal GBS screening and better understand the prevalence of maternal GBS colonization in Latin America. Further research on the burden of neonatal GBS disease within Latin America is needed to inform the introduction of a maternal GBS vaccine, when available.
OBJECTIVE: To determine rates and results of maternal Group B streptococcus (GBS) screening during pregnancy and identify sociodemographic characteristics associated with GBS screening in Latin American countries. BACKGROUND:GBS is a primary cause of morbidity and mortality in neonates and is prevented by screening pregnant women for GBS before delivery and intrapartum antibiotic treatment. Yet, data regarding national GBS screening practices and the epidemiology of maternal GBS colonization in Latin America are limited. METHODS: We conducted a retrospective observational study using de-identified records of pregnant women in six Latin American countries from a regional database. 460,328 collected from January 1, 2009 through December 31, 2012 met study criteria and were included. Maternal screening rates for GBS were determined, association of demographic variables (ethnicity, age, education level, and civil status) with maternal GBS screening was determined using logistic regression, odds ratios were calculated comparing incidence of adverse neonatal outcomes (sepsis, pneumonia, and meningitis) between countries with high and low rates of GBS screening, maternal GBS colonization prevalence was determined by year and association of demographic variables with maternal GBS colonization was determined using logistic regression. RESULTS: Maternal GBS screening was less than 15% in each country, except Uruguay which screened greater than 65% of women. The final regression model examining maternal screening rates and demographic variables included the covariates ethnicity, maternal age group, education level and civil status. Countries with lower rates of maternal GBS screening had increased odds of neonatal sepsis [OR 23.3; 95% CI (15.2-35.9)] and pneumonia [OR 19.9; 95% CI (12.1-32.6)]. In Uruguay, GBS prevalence over the study period was 18.5%. Black women, older women and women without a primary education had higher rates of GBS colonization (21.3%, 20.4% and 21.9% respectively). CONCLUSIONS: Our study highlights the need for national policy and investments to increase maternal GBS screening and better understand the prevalence of maternal GBS colonization in Latin America. Further research on the burden of neonatal GBS disease within Latin America is needed to inform the introduction of a maternal GBS vaccine, when available.