Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694573719090.pdf (Australia)
Submission to the Select Committee on Stillbirth Research and Education by Group B Strep International As CEO and Cofounder of Group B Strep International (GBSI), I respectfully request that you consider infection as a significant cause of stillbirth in the committee’s deliberations.

According to one study, up to 24% of stillbirths in developed countries may be attributable to infection.
It was noted that higher numbers may actually be associated with infection due to increased diagnostic and screening availability.1 A challenge to determining the number of stillbirths caused by infection, especially those which are not visually apparent, is that parents don’t always have pathology testing done and even if they choose to, fetal death records are not routinely updated with the final diagnosis to figure accurately in the burden of infection-caused stillbirth.
Many different microorganisms can cause infection in unborn babies.

Some of these are usually associated with infection acquired during labor and delivery, but can also cause miscarriage and stillbirth.
For example, Group B strep (GBS) causes an estimated 57,000 possibly even up to 314,600 unborn babies to die in their mother's womb or be born very sick each year(2,3), but the guidelines of many countries only address maternal GBS colonization during pregnancy in regards to early-onset prevention, not in regards to protecting the unborn baby from prenatal-onset GBS disease, which includes miscarriages and stillbirths caused by GBS.
Knowledge-based strategies to help protect unborn babies include informing pregnant women about what to do if they notice any signs and symptoms of preterm labor, decreased or no fetal movement or even frenzied movement or if they experience an unexplained fever.

Women should be informed to contact their care provider immediately if they experience any vaginitis symptoms for appropriate testing to determine and treat the cause.

Much research needs to be done in regards to prenatal-onset GBS disease.
Some prenatal-onset research topics proposed by parents of GBS-infected babies are: 1) Should pregnancy care be managed differently if a woman has GBS bacteriuria, a marker for heavy genital tract colonization?

GBS bacteriuria can increase the risk of early-onset GBS disease, but perhaps also prenatal-onset GBS disease.

Would a recheck or “test of cure” be prudent as well as sensitivity testing or periodic urine cultures?
2) Should pregnancy care be managed differently if vaginal/rectal test results show heavy colonization levels?

3) Considering that cervical/uterine blood may “feed” microorganisms and increase infection, should special consideration, such as antibiotics, be given to women who experience significant bleeding during pregnancy?
Stillbirth Research and EducationSubmission 269 Also, a surprising number of parents have related to GBSI that their health care providers were unaware that group B strep can cross intact membranes or infect babies before birth.

Perinatal infection training needs to be addressed in medical schools as well as continuing medical education.
An excellent presentation explaining the mechanism of how GBS can infect unborn babies is available at gbs- intl.org/presentations/gbs-as-a-cause-of-preterm-labor-pprom, presented by Dr. David M. Aronoff, GBSI Board member and Director of the Division of Infectious Diseases at the Vanderbilt University School of Medicine.
Other microorganisms such as E. coli and mycoplasmas can also cross intact membranes and be transported closer to the baby in utero by invasive procedures such as membrane “stripping” or “sweeping.” GBSI’s information statement is attached as to why GBSI advocates that fetal membrane stripping should be avoided.

Please note on the second page of the attachment that membrane stripping has not been proven to be safe.
According to the US Centers for Disease Control and Prevention, “data is insufficient.” In the interim, GBSI advocates informed consent be obtained prior to membrane stripping as would be done for any other medical procedure.

Sometimes providers will take it upon themselves to strip a woman’s fetal membranes without any forewarning in the course of a cervical check.

Women should be given the opportunity to have a voice in their care management.
Please visit gbs-intl.org/welcome to view the many excellent presentations from our recent online symposium on prenatal-onset group B strep disease (POGBSD) as well as our resource page on patient behaviors to help prevent many types of infection at gbs-intl.org/downloadable-prenatal-infection-prevention-materials.

Thank you for your work to prevent stillbirth!

Sincerely, Marti Perhach GBSI CEO and Cofounder www.groupbstrepinternational.org 1) Infectious causes of stillbirth: a clinical perspective.
EM McClure et al.

Clin Obstet Gynecol.

2010;53(3):635-45.

2) Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children.

AC Seale et al.

Clinical Infectious Diseases, Volume 65, Issue suppl_2, 6 November 2017, Pages S200–S219.

3) Maternal group B Streptococcus-related stillbirth: a systematic review.

C Nan et al.

BJOG.

2015 Oct;122(11):1437-45.

Stillbirth Research and EducationSubmission 269