背景:母体B组链球菌(GBS)定植受多种因素影响,但结果不一致。在普遍筛查不是标准护理的情况下,考虑产前风险因素可能有助于指导GBS微生物培养筛查的决策。我们试图确定在妊娠34-37周时GBS定植的独立预测因素,包括阴道症状,会阴卫生措施,性活动,和一个潜在的新因素,便秘。
方法:在这项前瞻性横断面研究中,573名妇女在妊娠34-37周时接受了阴道拭子,并送去进行GBS的选择性培养。女性被问及阴道出血,放电,刺激和念珠菌病,怀孕期间使用抗生素,如厕后冲洗和会阴清洁等阴道卫生习惯,性交相关活动,以及GBS运输的潜在新因素,便秘。还收集了产妇的基本人口统计学和产科相关特征。进行双变量分析以鉴定GBS定植的关联。然后将双变量分析中p<0.05的所有变量纳入多变量二元逻辑回归分析的模型中,以确定GBS定植的独立风险因素。
结果:在235/573(41.0%)的参与者中发现了GBS定植。二变量分析考虑了26个独立变量。发现八个具有p<0.05。调整后的分析,确定了GBS定殖的六个独立预测因子:种族,既往新生儿GBS预防,产前阴道刺激,抗生素使用,最近使用的内裤衬垫,和性交的频率。调整后阴道排出和会阴清洁无关。在双变量分析中,最近的冲洗和便秘没有相关性。
结论:确定妊娠晚期GBS定植的独立预测因子可能会告知妇女和护理提供者在妊娠35-38周时在普遍GBS筛查不是标准护理的地方进行微生物筛查的共同决策。
■本研究于2022年8月9日获得马来亚大学医学中心(UMMC)医学伦理委员会的批准,参考号2022328-11120。
BACKGROUND: Maternal Group B Streptococcus (GBS) colonization is influenced by many factors but results are inconsistent. Consideration of antenatal risk factors may help inform decision making on GBS microbiological culture screening where universal screening is not standard of care. We sought to identify independent predictors of GBS colonization at 34-37 weeks gestation incorporating vaginal symptoms, perineal hygiene measures, sexual activity, and a potential novel factor, constipation.
METHODS: In this prospective cross-sectional study, 573 women at 34-37 weeks gestation had an ano-vaginal swab taken and sent for selective culture for GBS. Women were asked about vaginal bleeding, discharge, irritation and candidiasis, antibiotic use during pregnancy, ano-vaginal hygiene practices such as douching and perineal cleansing after toileting, sexual intercourse related activities, and a potential novel factor for GBS carriage, constipation. Maternal basic demographics and obstetric-related characteristics were also collected. Bivariate analyses were performed to identify associates of GBS colonization. All variables with p < 0.05 found on bivariate analysis were then included into a model for multivariable binary logistic regression analysis to identify independent risk factors for GBS colonization.
RESULTS: GBS colonization was found in 235/573 (41.0%) of participants. Twenty six independent variables were considered for bivariate analysis. Eight were found to have p < 0.05. Following adjusted analysis, six independent predictors of GBS colonization were identified: ethnicity, previous neonatal GBS prophylaxis, antenatal vaginal irritation, antibiotic use, recent panty liner use, and frequency of sexual intercourse. Vaginal discharge and perineal cleansing were not associated after adjustment. Recent douching and constipation were not associated on bivariate analysis.
CONCLUSIONS: The identification of independent predictors of GBS colonization in late pregnancy may inform the woman and care provider in their shared decision making for microbiological screening at 35-38 weeks gestation in locations where universal GBS screening is not standard of care.
UNASSIGNED: This study was approved by the Medical Ethics Committee of University Malaya Medical Centre (UMMC) on August 9, 2022, reference number 2022328-11120.