Benefits and harms of antenatal/intrapartum screening for maternal GBS and use of intrapartum antibiotic prophylaxis versus risk-based protocols or no intervention: a rapid review

Aim: To synthesise evidence on the effectiveness, harms and benefits of different approaches to prevent early-onset GBS (EOGBS) and identify gaps in short and longer-term outcomes.<br/><br/>Methods: A two-phase rapid review. Phase 1 included an overview of systematic reviews (SRs). Phase 2 identified primary studies from SRs supplemented by additional searches. Outcomes included screening effectiveness, maternal and neonatal health outcomes and reported harms or benefits.<br/><br/>Results: Phase 1 identified three moderate-high quality reviews; 78 primary studies met phase 2 eligibility criteria. Any prevention strategy reduced EOGBS incidence, all-cause early-onset sepsis (EOS), and EOGBS-related mortality compared to no strategy. Universal screening was more effective in reducing EOGBS and all-cause EOS compared with risk-based approaches, with no <br/>evidence of any difference between the approaches for non-GBS EOS incidence or EOGBS-related mortality. Evidence was low to very-low certainty. Other neonatal outcomes (meningitis, pneumonia, late-onset GBS or maternal outcomes) were limited. Long-term child outcomes were under-reported. Few studies reported women’s views. Protocol violations and missed opportunities <br/>were reported. <br/><br/>Conclusion: Any prevention strategy reduces the incidence of EOGBS, all-cause EOS and EOGBS-related mortality compared to no strategy. Differences between universal and risk-based approaches remain unclear. Improved reporting, longer-term evaluation, and implementation focused research are needed.