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

Abstract

In Brief 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. Many women with vaginal and/or rectal group B streptococcal colonization have low concentrations of group B streptococcal serotype–specific immunoglobulin G in their delivery sera.