title: Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data.
abstract: OBJECTIVE
  The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk.
  
  
  METHODS
  A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel-Haenszel fixed effect model.
  
  
  RESULTS
  In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84-7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02-2.31).
  
  
  CONCLUSIONS
  Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m(2), race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.
authors.affiliation: Department of Obstetrics and Gynecology, Kelsey-Seybold Clinic, Houston, Texas.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Turrentine
authors.affiliation: Division of Maternal Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Colicchia
authors.affiliation: Department of Obstetrics and Gynecology, NorthShore University HealthSystem and University of Chicago, Evansten and Chicago, Illinois.
authors.forename: Emmet
authors.initials: E
authors.lastname: Hirsch
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, Presence Saint Francis Hospital, Chicago, Illinois.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tam
authors.affiliation: Division of Maternal Fetal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Ramsey
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Page-Ramsey
mesh_terms: D002353:Carrier State / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008403:Mass Screening; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D012008:Recurrence; D013290:Streptococcal Infections / Q000175:diagnosis*; D013292:Streptococcus agalactiae