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Group B Streptococcal Colonization and Serotype-Specific Immunity in Pregnant Women at Delivery

From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas; the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh and Magee-Women’s Research Institute, Pittsburgh, Pennsylvania; the Departments of Laboratory Medicine and Pathology and Pediatrics, University of Minnesota, Minneapolis, Minnesota; Channing Laboratory, Harvard Medical School, Boston, Massachusetts; and the Departments of Microbiology and Immunology, Baylor College of Medicine, Houston, Texas.

Address reprint requests to: Judith R. Campbell, MD Department of Pediatrics Baylor College of Medicine One Baylor Plaza, Room 302A Houston, TX 77030 E-mail: judithc{at}bcm.tmc.edu

Objective: To describe the relationship between serum concentration of group B streptococcal capsular polysaccharide–specific immunoglobulin (Ig) G, colonization status, race or ethnicity, and age in pregnant women.

Methods: Pregnant women (n = 3307) were enrolled from geographically and ethnically diverse populations. At the time of admission for delivery, swabs of the lower vagina and rectum were obtained for isolation of group B streptococci. In a subset of women whose sera were available, capsular polysaccharide–specific IgG concentrations were quantified by serotype-specific (Ia, Ib, II, III, and V) enzyme-linked immunosorbent assay and compared by group B streptococcal colonization status.

Results: Group B streptococcal colonization was detected in 856 women (26%), and the rate was significantly higher among black women (37%) than in other racial or ethnic groups (odds ratio 1.7, 95% confidence interval 1.4, 2.1). Colonization status did not differ by study site or age. Colonization with serotypes Ia, II, III, or V was associated with significantly higher serum concentrations of IgG specific for the capsular polysaccharide of the colonizing serotype compared with noncolonization. However, 48% of colonized women had low capsular polysaccharide–specific IgG levels (less than 0.5 µg/mL) in their delivery sera. Colonized teenagers had the lowest median concentration.

Conclusion: Colonization with group B streptococcus can elicit a systemic immune response, with a cumulative increase in the prevalence of capsular polysaccharide–specific IgG with increasing age. Conversely, low antibody levels in colonized teenagers might account in part for the reported increased risk of group B streptococcal disease in neonates born to these patients.

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