*Rx for Readers: Prenatal preparations*

Judy Siegel-Itzkovich helps readers with their medical and health queries.

A pregnant woman (photo credit: REUTERS)
A pregnant woman
(photo credit: REUTERS)
I am 26 and recently gave birth to my second child, a healthy boy, after having a daughter.
I did blood and urine tests, and even though everything else was normal, I learned I was positive for vaginal Group B Streptococcus (GBS). I do not feel any symptoms. My gynecologist didn’t explain what it means, but said only that before or during my next pregnancy, I would have to take antibiotics to prevent danger to myself and the baby.
What is GBS? How common is it? Where does it come from? Can one get rid of it, or is it a chronic condition? What precautions must one take before and during pregnancy, and what are the risks?
- T.R., Givat Shmuel
Prof. Simcha Yagel, head of the division of obstetrics and gynecology at Hadassah University Medical Center in Jerusalem’s Ein Kerem, replies: GBS is quite common in Israel – about 15 percent of the population is positive for GBS; in comparison, the US rate is up to 30%. We do not know why there is such a difference.
GBS are intestinal bacteria that colonize the intestines and reach the rectum, then the vagina during a first birth. During subsequent deliveries, this may cause problems for the baby, and rarely the mother (in these cases, a uterine infection can result). The bacteria do not remain in the rectum or vagina the entire time, but if they were there before, there is higher risk they will return.
The bacteria carried by the woman are harmless in her intestines, but during labor and delivery (or premature rupture of the membranes), they can infect the baby. If there is no treatment – intravenous antibiotics (penicillin) given just before or during labor – the infant can develop serious infections such as pneumonia or encephalitis (acute inflammation of the brain). Simple antiseptic wipes do not prevent mother-to-child transmission.
The bacteria may endanger newborns because they can be aspirated during birth.
No current cultured-based tests are both accurate and fast enough to recommend for detecting GBS once labor starts.
The only intervention for a patient who tests positive is to inform the caregivers in the delivery ward of her carrier status, if she is aware of it. She will then receive intravenous antibiotic therapy during labor (preferably penicillin), which will prevent the vast majority of the pathological conditions, including possible infection of the newborn.
Routine screening of pregnant women is performed in many countries, including the US, Canada, Australia, New Zealand, Belgium, France, Spain, Germany, Italy, Hong Kong, Bulgaria, the Czech Republic, Slovenia, Argentina and Kenya. However, in Israel, there is no screening policy during pregnancy – though many obstetricians do perform it, usually at 35 to 37 weeks of pregnancy. The Health Ministry has determined that universal screening is “not cost-effective.”
Thus, it is possible that a woman will give birth unintentionally or intentionally at home or in an ambulance on the way to the hospital – and would then not get treatment.
A Health Ministry spokesman added: There are two techniques for screening pregnant women for GBS – a bacterial test via a vagino-rectal smear at the 35th to 37th week of pregnancy, or screening according to risk factors; in Israel, the second one is recommended. In a woman with risk factors, or one who was found to have GBS between the 35th and 37th week, instructions specify giving her antibiotics during delivery to prevent early-onset invasive GBS disease.
The ministry’s Center for Disease Control monitors the rate of cases of this disease, and has found it low in Israel. Based on expert opinion, it was decided not to screen all pregnant women for this, but to treat those who have risk factors.
My four-month-old granddaughter suffers a great deal from silent reflux. My son, her father, is desperate – as she is getting no better despite seeing a top specialist since being born in London.
I have been told that silent reflux is the opposite of conventional reflux, because there is no regurgitation of acidic, semi-digested food to the esophagus and mouth. Is there any medical way to deal with it?
-M.N., London 
Prof. Francis Mimouni, head of neonatology at Jerusalem’s Shaare Zedek Medical Center, replies: We get this question very frequently. First of all, there is no need for a top specialist for gastroesophageal reflux disease (GERD); every well-trained general pediatrician should be able to handle it. Most experts in the field maintain that no tests should be performed on the baby; the diagnosis should be a clinical one.
It is nearly impossible for me to assess this child’s condition from afar. Indeed, it is critical to evaluate the signs and symptoms of a specific child and get a proper history, particularly to evaluate nutritional and growth history as well as the quality and quantity of symptoms. After this evaluation, it is important to reach a differential diagnosis. Babies who have been diagnosed with GERD may have never had GERD; in fact, they may have suffered from various other ailments such as cow’s-milk allergy, another food allergy (even if transmitted through breastfeeding, gut malrotation, unrecognized pyloric stenosis or something else).
Once GERD is truly diagnosed, there are very many different approaches, depending upon the child’s age, mode of feeding, severity of symptoms, whether growth is affected and so on.
There is an overall abuse of anti-reflux medications in children, and those infants who will likely benefit from their use must be carefully selected. I see very many infants with GERD in my clinic, and can say that no two are similar.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to [email protected], giving your initials, age and place of residence.