CompletedPregnancy, Children & Inherited ConditionsPublic Health & Healthcare
Suite of three rapid systematic reviews on incidence and natural history of all-cause and group B streptococcal (GBS) infection in the neonate, and on the clinical effectiveness of screening for maternal GBS carriage
Around one in five pregnant women carry Group B Streptococcus (GBS), a bacterium that can pass to newborns during labour and cause life-threatening infections such as sepsis, pneumonia, and meningitis. The UK National Screening Committee last reviewed whether to screen all pregnant women for GBS in 2017 and decided against it. This project updates that evidence base with three rapid systematic reviews: one on the current UK incidence and long-term consequences of neonatal GBS infection, a second on all-cause neonatal infections, and a third comparing screening-based protocols with risk-based or no-intervention approaches for preventing GBS disease in newborns. The problem is that the 2017 decision may no longer reflect recent data—UK Health Security Agency figures show early-onset GBS infections have declined but remain higher than late-onset cases, and new studies link GBS meningitis to neurodevelopmental impairments such as cerebral palsy and hearing loss. If the reviews find that screening reduces serious neonatal harm without excessive antibiotic use or other downsides, the UK could change its policy, potentially preventing hundreds of infant deaths and disabilities each year. This is a direct evaluation of a public health intervention, not fundamental science—its success would mean a clear, evidence-based recommendation for or against universal screening.
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Group B Streptococcus (GBS) is recognised clinically as a contributor to neonatal morbidity and mortality causing newborn sepsis, pneumonia and meningitis. A global incidence of 0.49 per 1000 live births has been estimated previously. GBS is a common commensal bacterium found in gastrointestinal or genitourinary tracts. While there are regional variations, globally around one fifth of pregnant women carry GBS, with a transmission rate from mother to baby of around 36% during labour and delivery, and an incidence of GBS disease of around 3% in babies colonised with GBS. Short-term health outcomes of maternal GBS may include premature birth and stillbirth and/or infant invasive GBS disease (iGBS). Severe neonatal sepsis with respiratory failure, cardiovascular dysfunction and impairment in at least two other organs has also been reported. Recent studies suggest that long term health outcomes of iGBS meningitis include neurodevelopmental impairments such as cerebral palsy, epilepsy and hearing impairments. A 2023 report by the UK Health Security Agency highlighted a decline in early onset GBS infection in England but this remains at a higher rate than late onset infection indicating an ongoing need to monitor the incidence and consequences of neonatal GBS infection. In the UK, screening for maternal GBS was last considered by the UK National Screening Committee (UK NSC) in 2017. The conclusion was not to recommend screening. The UK NSC has requested an update to some of the evidence syntheses undertaken for their 2017 report, to investigate any developments in the field that may inform discussion on continuing or changing the current recommendation on universal GBS screening. This project consists of three rapid reviews. • Review A investigates the incidence in the UK and health consequences of neonatal Group B Streptococcus (GBS) infections. • Review B assesses the incidence in the UK and health consequences of all-cause neonatal infection. • Review C evaluates the benefits and harms of antenatal or intrapartum screening for maternal GBS carriage and the subsequent use of intrapartum antibiotic prophylaxis. It compares screening-based protocols with risk-based and no-intervention approaches, focusing on maternal and neonatal health outcomes.
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