Challenging the validity of the new and old USA GBS guidelines. (Oct 2019)

Michael Harrop

Michael Harrop

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The problem and evidence:​

In Martin Blaser's "Missing Microbes" he says:
“Women in labor routinely get antibiotics to ward off infection after a C-section and to prevent an infection called Group B strep. About 40 percent of women in the United States today get antibiotics during delivery, which means some 40 percent of newborn infants are exposed to the drugs just as they are acquiring their microbes.

Thirty years ago, 2 percent of women developed infection after C-section. This was unacceptable, so now 100 percent get antibiotics as a preventive prior to the first incision. Only 1 in 200 babies actually gets ill from the Group B strep acquired from his or her mother. To protect 1 child, we are exposing 199 others to antibiotics”
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Because 1 baby was susceptible to GBS you've now permanently damaged the gut microbiome and immune system of 200 babies and 200 mothers, making them more susceptible to a variety of diseases and infections, and likely lowering their overall level of function. All in order to save 1 infant.

That would be bad enough if prophylactic (preventative) antibiotics was proven to prevent complications from GBS. But is it?

A 2014 Cochrane review found that "giving antibiotics is not supported by conclusive evidence, no clear differences in newborn deaths". Intrapartum antibiotics for known maternal Group B streptococcal colonization (2014).

Then in 2019, an Australian study of 62,281 women who had 92,055 pregnancies found that "Seven of 10 term babies with EOGBS (early-onset group B streptococcal infection) were born to mothers who screened negative. No change was detected in rates of neonatal EOGBS over time and no difference in EOGBS in babies of screened and unscreened populations. Limitations of universal screening suggest alternatives be considered." Group B streptococcal screening, intrapartum antibiotic prophylaxis, and neonatal early-onset infection rates in an Australian local health district: 2006-2016 (April 2019).


Despite that, the recent US 2019 "update" continues to recommend universal screening. IE: test all mothers for GBS and administer antibiotics if they test positive.
The CDC guidelines from 2010 recommended the universal screening approach. And they reference the 2019 update done by The American College of Obstetricians and Gynecologists (ACOG).


I see many parents/laypeople citing this overview in support of the current guidelines: https://evidencebasedbirth.com/groupbstrep/
  1. In my opinion, it does not support the current guidelines. Rather, it merely states facts. And in my opinion, those facts do not support antibiotics for GBS.
  2. It is not up to date. It posits that antibiotic damage is only temporary, which is dangerous misinformation.

What I did:​

  • I tried going directly to parents. In my experience, this is not a valid route. Most people lack the ability/expertise/knowledge to scientifically/objectively analyze the information and change their current views based on it. A large percentage seem driven/clouded by emotion. Though both of these issues seem to apply to many people with PhDs as well.
  • I wrote to the author of the 2019 update. They did not respond.
  • Martin Blaser was appointed to the Health and Human Services antibiotic advisory council (2015) [1][2]. Isn't this their job? Why should I be doing this? Yet I've written to them multiple times, on this and other subjects, and never received a response about what their position is or what actions they are taking.
  • I wrote to the CDC. They referred me to the authors of the guidelines - The American College of Obstetricians and Gynecologists (ACOG). I wrote to them, and they have only given a short request for more [unrelated] info, which I provided, and have not received a further response (for weeks).

My correspondence to them:​

The new GBS guidelines don't seem to reflect either of these:
It also does a poor job of weighing the microbiome damage. It only references a small amount of the relevant microbiome research:
And says "Whether the secondary effects of IAP on the microbiome influence short- and long-term childhood health outcomes is unknown" right after listing a bunch of evidence that the harms are known.

Not only is it not ethical to damage/harm 199 mothers and babies in order to save 1 life, but antibiotics for GBS isn't even evidence-based.

And even beyond that, the sole focus on infant deaths is misguided in my opinion. Quality of life is more important, and you have to weigh the detriments of antibiotics on the mother & child, and the generational consequences.

I think the prevalent attitude of "save an infant's life at all costs" isn't ethical or sensible, and has been contributing to a wide variety of societal problems related to a population where the majority of people are now extremely poorly developed and poorly functioning.

Taken all together it is horrifying that 30% of mothers and babies are being exposed to antibiotics for a use with no scientifically proven benefits.
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Original 29 Oct 2019 (9 comments).
 
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