Benefits and Harms of Antenatal/Intrapartum Screening for Maternal Group B Streptococcus and Use of Intrapartum Antibiotic Prophylaxis Versus Risk-Based Protocols or No Intervention: A Rapid Review.

AIM: To synthesise evidence on the effectiveness, harms and benefits of different approaches to prevent early-onset Group B Streptococcus (EOGBS) and identify gaps in short and longer-term outcomes.

METHODS

A two-phase rapid review. Phase 1 included an overview of systematic reviews (SRs). Phase 2 identified primary studies from SRs supplemented by additional searches. Outcomes included screening effectiveness, maternal and neonatal health outcomes and reported harms or benefits.

RESULTS

Phase 1 identified three moderate-high quality reviews; 78 primary studies met phase 2 eligibility criteria. Any prevention strategy reduced EOGBS incidence, all-cause early-onset sepsis (EOS) and EOGBS-related mortality compared to no strategy. Universal screening was more effective in reducing EOGBS and all-cause EOS compared with risk-based approaches, with no evidence of any difference between the approaches for non-GBS EOS incidence or EOGBS-related mortality. Evidence was low to very-low certainty. Other neonatal outcomes (meningitis, pneumonia, late-onset GBS or maternal outcomes) were limited. Long-term child outcomes were under-reported. Few studies reported women's views. Protocol violations and missed opportunities were reported.

CONCLUSION

Any prevention strategy reduces the incidence of EOGBS, all-cause EOS and EOGBS-related mortality compared to no strategy. Differences between universal and risk-based approaches remain unclear. Improved reporting, longer-term evaluation and implementation-focused research are needed.