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Review
. 2017 Nov 6;65(suppl_2):S125-S132.
doi: 10.1093/cid/cix585.

Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses

Anna C Seale  1   2 , Hannah Blencowe  1 , Fiorella Bianchi-Jassir  1 , Nicholas Embleton  3 , Quique Bassat  4   5   6 , Jaume Ordi  6   7 , Clara Menéndez  4   6   8 , Clare Cutland  9 , Carmen Briner  9 , James A Berkley  10   11 , Joy E Lawn  1 , Carol J Baker  12 , Linda Bartlett  13 , Michael G Gravett  14   15 , Paul T Heath  16 , Margaret Ip  17 , Kirsty Le Doare  16   18 , Craig E Rubens  14   19 , Samir K Saha  20 , Stephanie Schrag  21 , Ajoke Sobanjo-Ter Meulen  22 , Johan Vekemans  23 , Shabir A Madhi  9   24
Affiliations
Review

Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses

Anna C Seale et al. Clin Infect Dis. .

Abstract

Background: There are an estimated 2.6 million stillbirths each year, many of which are due to infections, especially in low- and middle-income contexts. This paper, the eighth in a series on the burden of group B streptococcal (GBS) disease, aims to estimate the percentage of stillbirths associated with GBS disease.

Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, World Health Organization Library Information System, and Scopus) and sought unpublished data from investigator groups. Studies were included if they reported original data on stillbirths (predominantly ≥28 weeks' gestation or ≥1000 g, with GBS isolated from a sterile site) as a percentage of total stillbirths. We did meta-analyses to derive pooled estimates of the percentage of GBS-associated stillbirths, regionally and worldwide for recent datasets.

Results: We included 14 studies from any period, 5 with recent data (after 2000). There were no data from Asia. We estimated that 1% (95% confidence interval [CI], 0-2%) of all stillbirths in developed countries and 4% (95% CI, 2%-6%) in Africa were associated with GBS.

Conclusions: GBS is likely an important cause of stillbirth, especially in Africa. However, data are limited in terms of geographic spread, with no data from Asia, and cases worldwide are probably underestimated due to incomplete case ascertainment. More data, using standardized, systematic methods, are critical, particularly from low- and middle-income contexts where the highest burden of stillbirths occurs. These data are essential to inform interventions, such as maternal GBS vaccination.

Keywords: estimates; group B Streptococcus; mortality; stillbirth; stillborn.

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Figures

Figure 1.
Figure 1.
Group B Streptococcus (GBS)–associated stillbirth in disease schema for GBS, as described by Lawn et al [15].
Figure 2.
Figure 2.
Data search and included studies on group B Streptococcus–associated stillbirth.
Figure 3.
Figure 3.
Geographic distribution of data on group B Streptococcus (GBS)–associated stillbirth (all years). Borders of countries/territories in map do not imply any political statement.
Figure 4.
Figure 4.
Pooled estimates (with 95% confidence interval [CI]) of proportion of group B Streptococcus (GBS)–associated stillbirth for regions with data since 2000, split by region (5 studies, N = 89).
See this image and copyright information in PMC

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