Groep B Streptokokken (GBS)

Geschreven door Margot van Dijk
Gepubliceerd in mei 2025

Niet eerder was het schrijven van een artikel zo’n klus als bij dit onderwerp: GBS. In plaats van objectief naar GBS en de beste benadering te kijken, is de richtlijn toegeschreven naar een uitkomst die al vaststond: het screenen van zwangeren en behandelen met antibioticaprofylaxe tijdens de baring.

Het beleid is gestoeld op veel aannames. Dit is te merken aan essentiële vragen die niet zijn gesteld en beantwoord in de richtlijn. Bijvoorbeeld:

Heeft GBS een functie in het spijsverteringskanaal?
Waarom loopt de prevalentie van GBS-dragerschap zo uiteen?
Hoe betrouwbaar en valide is screenen op GBS?
Waarom worden de meeste baby’s níet ziek door GBS?
Hoe zeker zijn we dat een early-onset GBS-infectie bij de baby komt door overdracht van GBS door de moeder?
Is het terecht om een moeder te screenen en behandelen, met daarbij verschillende risico’s voor haarzelf, om de baby misschien te beschermen?

Enerzijds is er de heftigheid van een early-onset GBS-infectie bij de baby, die in enkele gevallen tot overlijden leidt. Anderzijds is er de schade die op grote schaal wordt aangericht door het toedienen van antibioticaprofylaxe aan grote groepen zwangeren en hun baby’s. Is dat gerechtvaardigd of is het mogelijk in strijd met onze beroepseed ‘first do no harm’?

Het doel van dit artikel is om zorgverleners en zwangeren inzicht te geven in de onderbouwing van het huidige beleid rondom GBS en de pijnpunten in dit beleid ook in kaart te brengen.

Ik heb op geen enkele manier baat bij de keuzes die een zwangere maakt en mijn doel is ook niet om daarin te sturen. Dit artikel kan het gesprek tussen zorgverlener en zwangere niet vervangen.

Zoals altijd geldt ook bij GBS: in de wet is vastgelegd dat de zwangere recht heeft op volledige informatie en dat zij degene is die de eindbeslissing neemt over de zorg die zij wel of niet wenst te ontvangen. Meer hierover lees je in het artikel Rechten en plichten in de geboortezorg.

Heb je een vraag? Kom dan naar het maandelijkse Vragen(v)uur. Zorgverleners kunnen hun vraag ook stellen in de community.

ACOG. Prevention of Group B Streptococcal Early-Onset Disease in Newborns. (2019). Pediatrics, 144(2), e20191882. https://doi.org/10.1542/peds.2019-1882
Ainonen, S., Ronkainen, E., Hakkola, M., Pokka, T., Honkila, M., Paalanne, M., Kajantie, E., Paalanne, N., & Ruuska, T. S. (2024). Risk of immune-related diseases in childhood after intrapartum antibiotic exposure. American journal of obstetrics and gynecology, 231(4), 454.e1–454.e10. https://doi.org/10.1016/j.ajog.2024.02.020
Armistead, B., Oler, E., Adams Waldorf, K., & Rajagopal, L. (2019). The Double Life of Group B Streptococcus: Asymptomatic Colonizer and Potent Pathogen. Journal of molecular biology, 431(16), 2914–2931. https://doi.org/10.1016/j.jmb.2019.01.035
ASM (American Society for Microbiology). (2021). Guidelines for the Detection and Identification of Group B Streptococcus. In https://asm.org/Guideline/Guidelines-for-the-Detection-and-Identification-of. https://asm.org/Guideline/Guidelines-for-the-Detection-and-Identification-of
Association of Ontario Midwives. Antepartum, Intrapartum and Postpartum Management of Group B Streptococcus. 2022 (Clinical Practice Guideline No. 19). https://www.ontariomidwives.ca/sites/default/files/2022-05/CPG-Group%20B%20Streptcoccous-PUB.pdf
Azad, M. B., Konya, T., Persaud, R. R., Guttman, D. S., Chari, R. S., Field, C. J., Sears, M. R., Mandhane, P. J., Turvey, S. E., Subbarao, P., Becker, A. B., Scott, J. A., Kozyrskyj, A. L., & CHILD Study Investigators (2016). Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG : an international journal of obstetrics and gynaecology, 123(6), 983–993. https://doi.org/10.1111/1471-0528.13601
Berardi, A., Spada, C., Creti, R., Ambretti, S., Chiarabini, R., Barozzi, A., Pagano, R., Sarti, M., Pedna, M. F., Fornaciari, S., Azzalli, M., Dodi, I., Bacchi Reggiani, M. L., Lanzoni, A., Vaccina, E., Iughetti, L., & Lucaccioni, L. (2020). Risk factors for group B streptococcus early-onset disease: an Italian, area-based, case-control study. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(14), 2480–2486. https://doi.org/10.1080/14767058.2019.1628943
Bevan D, White A, Marshall J, Peckham C. Modelling the effect of the introduction of antenatal screening for group B Streptococcus (GBS) carriage in the UK. BMJ Open. 2019 Mar 23;9(3):e024324. doi: 10.1136/bmjopen-2018-024324. PMID: 30904850; PMCID: PMC6475221.
Cai, M., Loy, S. L., Tan, K. H., Godfrey, K. M., Gluckman, P. D., Chong, Y. S., Shek, L. P., Cheung, Y. B., Lek, N., Lee, Y. S., Chan, S. Y., Chan, J. K. Y., Yap, F., & Ang, S. B. (2018). Association of Elective and Emergency Cesarean Delivery With Early Childhood Overweight at 12 Months of Age. JAMA network open, 1(7), e185025. https://doi.org/10.1001/jamanetworkopen.2018.5025
Collin, S. M., Shetty, N., Guy, R., Nyaga, V. N., Bull, A., Richards, M. J., van der Kooi, T. I. I., Koek, M. B. G., De Almeida, M., Roberts, S. A., & Lamagni, T. (2019). Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 83, 116–129. https://doi.org/10.1016/j.ijid.2019.04.017
Cutler, R. R., Odent, M., Hajj-Ahmad, H., Maharjan, S., Bennett, N. J., Josling, P. D., Ball, V., Hatton, P., & Dall'Antonia, M. (2009). In vitro activity of an aqueous allicin extract and a novel allicin topical gel formulation against Lancefield group B streptococci. The Journal of antimicrobial chemotherapy, 63(1), 151–154. https://doi.org/10.1093/jac/dkn457
de Gier, B., van Kassel, M. N., Sanders, E. A. M., van de Beek, D., Hahné, S. J. M., van der Ende, A., & Bijlsma, M. W. (2019). Disease burden of neonatal invasive Group B Streptococcus infection in the Netherlands. PloS one, 14(5), e0216749. https://doi.org/10.1371/journal.pone.0216749
de Goffau, M. C., Lager, S., Sovio, U., Gaccioli, F., Cook, E., Peacock, S. J., Parkhill, J., Charnock-Jones, D. S., & Smith, G. C. S. (2019). Human placenta has no microbiome but can contain potential pathogens. Nature, 572(7769), 329–334. https://doi.org/10.1038/s41586-019-1451-5
El Aila, N. A., Tency, I., Claeys, G., Saerens, B., Cools, P., Verstraelen, H., Temmerman, M., Verhelst, R., & Vaneechoutte, M. (2010). Comparison of different sampling techniques and of different culture methods for detection of group B streptococcus carriage in pregnant women. BMC infectious diseases, 10, 285. https://doi.org/10.1186/1471-2334-10-285
Fan, Shang-Rong; Tasneem, Umber; Liu, Xiao-Ping; Yan, Shao-Mei. Prevention of Perinatal Group B Streptococcus Infections. Maternal-Fetal Medicine 2(2):p 100-109, April 2020. Doi: 10.1097/FM9.0000000000000041
Glantz JC, Kedley KE. Concepts and controversies in the management of group B streptococcus during pregnancy. Birth. 1998 Mar;25(1):45-53. doi: 10.1046/j.1523-536x.1998.00045.x. PMID: 9534505. Gray, B. M., & Stevens, D. L. (2009). Streptococcal Infections. Bacterial Infections of Humans: Epidemiology and Control, 743–782. https://doi.org/10.1007/978-0-387-09843-2_35
Hamada, S., Vearncombe, M., McGeer, A., & Shah, P. S. (2008). Neonatal group B streptococcal disease: Incidence, presentation, and mortality. The Journal of Maternal-Fetal & Neonatal Medicine, 21(1), 53–57. https://doi.org/10.1080/14767050701787474
van Kassel, M. N., Janssen, S. W. C. M., Kofman, S., Brouwer, M. C., van de Beek, D., & Bijlsma, M. W. (2021). Prevalence of group B streptococcal colonization in the healthy non-pregnant population: a systematic review and meta-analysis. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 27(7), 968–980. https://doi.org/10.1016/j.cmi.2021.03.024
KNOV (2018). Time Task Matrix (TTM) Preventie en behandeling van early-onset Groep-B-Streptokok (GBS) Li, S., Huang, J., Chen, Z., Guo, D., Yao, Z., & Ye, X. (2017). Antibiotic Prevention for Maternal Group B Streptococcal Colonization on Neonatal GBS-Related Adverse Outcomes: A Meta-Analysis. Frontiers in microbiology, 8, 374. https://doi.org/10.3389/fmicb.2017.00374
Lin, F. Y., Weisman, L. E., Azimi, P., Young, A. E., Chang, K., Cielo, M., Moyer, P., Troendle, J. F., Schneerson, R., & Robbins, J. B. (2011). Assessment of intrapartum antibiotic prophylaxis for the prevention of early-onset group B Streptococcal disease. The Pediatric infectious disease journal, 30(9), 759–763. https://doi.org/10.1097/INF.0b013e31821dc76f
Ma'ayeh, M., Rood, K. M., Walker, H. C., Oliver, E. A., Gee, S. E., & Iams, J. D. (2019). Vaginal progesterone is associated with decreased group B streptococcus colonisation at term: a retrospective cohort study. BJOG : an international journal of obstetrics and gynaecology, 126(9), 1141–1147. https://doi.org/10.1111/1471-0528.15801
Nanduri, S. A., Petit, S., Smelser, C., Apostol, M., Alden, N. B., Harrison, L. H., Lynfield, R., Vagnone, P. S., Burzlaff, K., Spina, N. L., Dufort, E. M., Schaffner, W., Thomas, A. R., Farley, M. M., Jain, J. H., Pondo, T., McGee, L., Beall, B. W., & Schrag, S. J. (2019). Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance. JAMA pediatrics, 173(3), 224–233.
https://doi.org/10.1001/jamapediatrics.2018.4826
NICE. (2021, April 20). Recommendations | Neonatal infection: antibiotics for prevention and treatment | Guidance | NICE. https://www.nice.org.uk/guidance/ng195/chapter/recommendations
NVOG (2017) https://www.nvog.nl/wp-content/uploads/2018/02/ad2-GBS-sneldiagnostiek.pdf
NVOG (2017b) https://www.nvog.nl/wp-content/uploads/2018/02/ad1-Risico-op-en-gevolgen-van-early-onset-neonatale-GBS-infecties.pdf
NvK (2017). Preventie en behandeling van early-onset neonatale infecties. URL: https://richtlijnendatabase.nl/richtlijn/preventie_en_behandeling_van_early-onset_neonatale_infecties/informatie_en_ondersteuning_bij_early-onset_neonatale_infecties.html
Odubamowo, K., Garcia, M., Muriithi, F., Ogollah, R., Daniels, J. P., & Walker, K. F. (2023). Self-collected versus health-care professional taken swab for identification of vaginal-rectal colonisation with group B streptococcus in late pregnancy: a systematic review. European journal of obstetrics, gynecology, and reproductive biology, 286, 95–101. https://doi.org/10.1016/j.ejogrb.2023.05.027
Ohlsson, A. (1992). Perinatal group B streptococcal infections. Canadian Journal of Obstetrics/Gynaecology & Women's Health Care, 4, 355-63.
Ohlsson, A., & Myhr, T. L. (1994). Intrapartum chemoprophylaxis of perinatal group B streptococcal infections: a critical review of randomized controlled trials. American journal of obstetrics and gynecology, 170(3), 910–917. https://doi.org/10.1016/s0002-9378(94)70307-8
Ohlsson, A., & Shah, V. S. (2014). Intrapartum antibiotics for known maternal Group B streptococcal colonization. The Cochrane database of systematic reviews, (6), CD007467. https://doi.org/10.1002/14651858.CD007467.pub4
Puopolo, K. M., Lynfield, R., Cummings, J. J., COMMITTEE ON FETUS AND NEWBORN, & COMMITTEE ON INFECTIOUS DISEASES (2019). Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics, 144(2), e20191881. https://doi.org/10.1542/peds.2019-1881
Russell, N. J., Seale, A. C., O'Sullivan, C., Le Doare, K., Heath, P. T., Lawn, J. E., Bartlett, L., Cutland, C., Gravett, M., Ip, M., Madhi, S. A., Rubens, C. E., Saha, S. K., Schrag, S., Sobanjo-Ter Meulen, A., Vekemans, J., & Baker, C. J. (2017). Risk of Early-Onset Neonatal Group B Streptococcal Disease With Maternal Colonization Worldwide: Systematic Review and Meta-analyses. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 65(suppl_2), S152–S159. https://doi.org/10.1093/cid/cix655
RIVM (z.d.). Groep B-streptokokkeninfecties (GBS) en zwangerschap. https://www.rivm.nl/Streptokokken/GroepB-streptokokkeninfecties
Seale, A. C., Blencowe, H., Bianchi-Jassir, F., Embleton, N., Bassat, Q., Ordi, J., Menéndez, C., Cutland, C., Briner, C., Berkley, J. A., Lawn, J. E., Baker, C. J., Bartlett, L., Gravett, M. G., Heath, P. T., Ip, M., Le Doare, K., Rubens, C. E., Saha, S. K., Schrag, S., … Madhi, S. A. (2017). Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 65(suppl_2), S125–S132. https://doi.org/10.1093/cid/cix585
Stephens, K., Charnock-Jones, D. S., & Smith, G. C. S. (2023). Group B Streptococcus and the risk of perinatal morbidity and mortality following term labor. American journal of obstetrics and gynecology, 228(5S), S1305–S1312. https://doi.org/10.1016/j.ajog.2022.07.051
Seedat, F., Geppert, J., Stinton, C., Patterson, J., Freeman, K., Johnson, S. A., Fraser, H., Brown, C. S., Uthman, O. A., Tan, B., Robinson, E. R., McCarthy, N. D., Clarke, A., Marshall, J., Visintin, C., Mackie, A., & Taylor-Phillips, S. (2019). Universal antenatal screening for group B streptococcus may cause more harm than good. BMJ (Clinical research ed.), 364, l463. https://doi.org/10.1136/bmj.l463
Stephens, K., Charnock-Jones, D. S., & Smith, G. C. S. (2023). Group B Streptococcus and the risk of perinatal morbidity and mortality following term labor. American journal of obstetrics and gynecology, 228(5S), S1305–S1312. https://doi.org/10.1016/j.ajog.2022.07.051
Tajik, P., van der Ham, D. P., Zafarmand, M. H., Hof, M. H., Morris, J., Franssen, M. T., de Groot, C. J., Duvekot, J. J., Oudijk, M. A., Willekes, C., Bloemenkamp, K. W., Porath, M., Woiski, M., Akerboom, B. M., Sikkema, J. M., Nij Bijvank, B., Mulder, A. L., Bossuyt, P. M., & Mol, B. W. (2014). Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials. BJOG : an international journal of obstetrics and gynaecology, 121(10), 1263–1273. https://doi.org/10.1111/1471-0528.12889
Trijbels-Smeulders, M., de Jonge, G. A., Pasker-de Jong, P. C., Gerards, L. J., Adriaanse, A. H., van Lingen, R. A., & Kollée, L. A. (2007). Epidemiology of neonatal group B streptococcal disease in the Netherlands before and after introduction of guidelines for prevention. Archives of disease in childhood. Fetal and neonatal edition, 92(4), F271–F276. https://doi.org/10.1136/adc.2005.088799
Valkenburg-van den Berg, A. W., Sprij, A. J., Oostvogel, P. M., Mutsaers, J. A., Renes, W. B., Rosendaal, F. R., & Joep Dörr, P. (2006). Prevalence of colonisation with group B Streptococci in pregnant women of a multi-ethnic population in The Netherlands. European journal of obstetrics, gynecology, and reproductive biology, 124(2), 178–183. https://doi.org/10.1016/j.ejogrb.2005.06.007
Valkenburg-van den Berg, A. W., Sprij, A. J., Dekker, F. W., Dörr, P. J., & Kanhai, H. H. (2009). Association between colonization with Group B Streptococcus and preterm delivery: a systematic review. Acta obstetricia et gynecologica Scandinavica, 88(9), 958–967. https://doi.org/10.1080/00016340903176800
Van Dyke, M. K., Phares, C. R., Lynfield, R., Thomas, A. R., Arnold, K. E., Craig, A. S., Mohle-Boetani, J., Gershman, K., Schaffner, W., Petit, S., Zansky, S. M., Morin, C. A., Spina, N. L., Wymore, K., Harrison, L. H., Shutt, K. A., Bareta, J., Bulens, S. N., Zell, E. R., Schuchat, A., … Schrag, S. J. (2009). Evaluation of universal antenatal screening for group B streptococcus. The New England journal of medicine, 360(25), 2626–2636. https://doi.org/10.1056/NEJMoa0806820
Verani, J. R., McGee, L., Schrag, S. J., & Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC) (2010). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 59(RR-10), 1–36. Wickham, S. (2003). The war on Group B strep. AIMS Journal, 15(4). https://www.aims.org.uk/journal/item/the-war-on-group-b-strep
Wickham, S. (2019). Group B Strep explained. Birthmoon creations. Yancey, M. K., Schuchat, A., Brown, L. K., Ventura, V. L., & Markenson, G. R. (1996). The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstetrics and gynecology, 88(5), 811–815. https://doi.org/10.1016/0029-7844(96)00320-1
Young, B. C., Dodge, L. E., Gupta, M., Rhee, J. S., & Hacker, M. R. (2011). Evaluation of a rapid, real-time intrapartum group B streptococcus assay. American journal of obstetrics and gynecology, 205(4), 372.e1–372.e3726. https://doi.org/10.1016/j.ajog.2011.06.087
Zanetti-Dällenbach, R. A., Holzgreve, W., & Hösli, I. (2007). Neonatal group B streptococcus colonization in water births. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 98(1), 54–55. https://doi.org/10.1016/j.ijgo.2007.03.029
Zhu, Y., Huang, J., Lin, X. Z., & Chen, C. (2019). Group B Streptococcus Colonization in Late Pregnancy and Invasive Infection in Neonates in China: A Population-Based 3-Year Study. Neonatology, 115(4), 301–309. https://doi.org/10.1159/000494133