Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study.
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2019-01
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Abstract
Background:Maternal GBS colonization is associated with early-onset neonatal sepsis and extensive efforts are directed to preventing this complication. Less is known about maternal risks of GBS colonization. We seek to provide a modern estimate of the incidence and impact of maternal GBS colonization and invasive GBS disease. Methods:A single center historical cohort study of all births between 2003 and 2015 was performed. Data was collected via electronic health record abstraction using an institutional specific tool. Descriptive statistics were performed regarding GBS status. Inferential statistics were performed comparing risk of adverse pregnancy outcomes in cohorts with and without GBS colonization as well as cohorts with GBS colonization and invasive GBS disease. Results:A total of 60,029 deliveries were included for analysis. Overall, 21.6% of the population was GBS colonized and 0.1% had invasive GBS disease. GBS colonization was associated with younger maternal age, Black race, non-Hispanic ethnicity, chronic hypertension, preexisting diabetes, and tobacco use (p<0.01). In the adjusted analyses, there was an increased risk of gestational diabetes (aRR 1.21, 95% CI 1.11-1.32) in colonized pregnancies and a decreased incidence of short cervix (aRR 0.64, 95% CI 0.52-0.79), chorioamnionitis (aRR 0.76, 95% CI 0.66-0.87), wound infection (aRR 0.75, 95% CI 0.64-0.88), and operative delivery (aRR 0.85, 95% CI 0.83-0.88). Conclusions:This modern-day large cohort of all births over a 12-year period demonstrates a GBS colonization rate of 21.6%. This data reflects a need to assess maternal and perinatal outcomes in addition to neonatal GBS sepsis rates to inform decisions regarding the utility of maternal vaccination.
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Edwards, James M, Nora Watson, Chris Focht, Clara Wynn, Christopher A Todd, Emmanuel B Walter, R Phillips Heine, Geeta K Swamy, et al. (2019). Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study. Infectious diseases in obstetrics and gynecology, 2019. p. 5430493. 10.1155/2019/5430493 Retrieved from https://hdl.handle.net/10161/18200.
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Emmanuel Benjamin Walter
Dr. Emmanuel Walter, MD, MPH, Professor of Pediatrics, serves as the Duke Human Vaccine Institute (DHVI) Chief Medical Officer and directs the Duke Vaccine and Trials Unit. In these roles, Dr. Walter provides strategic and operational leadership for clinical research conducted at the Institute. In addition, he provides oversight of regulatory compliance for DHVI clinical research activities.
Dr. Walter has dedicated his career to advancing research and clinical practice in vaccinology, infectious diseases, and child health. He currently serves as the principal investigator for the Duke Clinical Core of the Collaborative Influenza Vaccine Innovations Centers (CIVICs) funded by the National Institute of Allergy and Infectious Diseases (NIAID). The goal of this work is to evaluate promising next generation influenza vaccine candidates in Phase I and Phase I/II clinical trials and human challenge studies. He is also the Duke Principal Investigator for the CDC-funded Clinical Immunization Safety Assessment Project which conducts studies to identify risk factors and preventive strategies for adverse events following immunization, particularly in special populations. Lastly, he is the Principal Investigator for the CDC-funded coordinating center of the influenza and other respiratory virus vaccine effectiveness network. This work provides national estimates for influenza and other respiratory virus vaccine effectiveness in persons presenting with respiratory illness in the ambulatory setting.
Dr. Walter's focused area of interest include vaccine development, vaccine safety, vaccine effectiveness, vaccine coverage, prevention and treatment of infectious diseases.
Geeta Krishna Swamy
Geeta Swamy, MD, Haywood Brown, MD Distinguished Professor of Women’s Health, serves as Executive Vice Dean for Clinical Sciences & Research Administration for the Duke University School of Medicine and Associate Vice President for Research for Duke University. In these roles, Dr. Swamy oversees central operations aligned with clinical departments and research centers, facilitating research priorities in collaboration with clinical chairs and vice chairs, and managing research administration and compliance. She works closely with leadership across the Duke Health Integrated Practice (DHIP) and Duke University Health System (DUHS) on areas that intersect with the academic missions. She collaborates with leaders across the Duke University campus to provide a consistent vision for research administration, operations, quality, and accountability. Her responsibilities include overseeing pre- and post-award management for sponsored grants and contracts, human research, research quality, compliance, and integrity, conflict of interest, and other regulatory areas. As a highly accomplished clinician-scientist, Dr. Swamy’s research specializes in perinatal infection, maternal immunization, and complications of pregnancy.
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