Let’s talk about your vaginal microbiome! While the gastrointestinal (gut) microbiome has become a wildly trendy topic in recent years, the vaginal microbiota needs some catch-up. There’s lots to discuss about vaginal bacteria, and we will. Right now this post is for you if you are pregnant or trying to conceive, and want to prevent a GBS (Group B Strept) positive test.
Who should care about GBS?
All pregnant women! GBS “colonization” is common, 1 in 3-4 women test positive. By the way, GBS is a bacteria that can live in your gastrointestinal and urogenital tracts, and is fine in tiny amounts. It is not fine if it overgrows during pregnancy. An overgrowth can cause serious consequences for your baby, including meningitis, sepsis, pneumonia, or stillbirth.
That’s why we take antibiotics! To be on the safe side. If you are positive, there’s a 50% chance your baby will be infected during a vaginal birth. However, of this 50%, it’s actually just a small number that develop GBS disease – whether or not you take antibiotics. The current CDC statistics are:
“A pregnant woman who tests positive for group B strep bacteria and gets antibiotics during labor has only a 1 in 4,000 chance of delivering a baby who will develop group B strep disease. If she does not receive antibiotics during labor, her chance of delivering a baby who will develop group B strep disease is 1 in 200.”
So since IV antibiotics lower the serious risks for your baby, why would you choose not to take them? It’s the universal standard of care in the U.S. In fact, 20-30% of women get IV antibiotics during labor.
What is the big deal?
why try to prevent gbs and inevitable antibiotics?
Some women learn about GBS and realize it’s their own personal risk/benefit decision. We know the benefits of antibiotics but, what are the risks? The concern here is the same as the concern with antibiotics in general – do they wipe out beneficial bacteria? Do the beneficials come back? Will the antibiotics cause fungal overgrowth? Do they cause antibiotic-resistant (“superbug”) bacteria?
What do we know?
GBS antibiotics, like all antibiotics, have a collateral effect on your beneficial bacteria. Therefore, the microbial seeding your baby gets during a vaginal birth is altered. So far, the limited research shows that in the short-term (up to 12 weeks), your baby will have fewer beneficial microbes and more undesirable ones. There is a delay for your baby in assembling his or her permanent (adult) bacteria populations.
The longer your labor, and the more time on antibiotics, the longer delay your baby will have in assembling an optimal microbiota.
What can we guess?
We do not know the long-term effects of GBS antibodies on your baby’s microbiota. However, we do have evidence that C-section births, which also result in an altered microbiota, may have long-term effects. C-section births are correlated with increased rates of asthma, allergies, celiac disease, type 1 diabetes, and obesity. So, theoretically, because of an early altered microbiota, GBS-antibiotic babies may have similar long-term risks.
These researchers write:
“It is becoming increasingly evident that antibiotic-induced perturbation in the early microbiota may have profound consequences for later health. Different animal studies have demonstrated that the alteration of the early microbiota with antibiotics increases the risk for autoimmune and metabolic diseases, also affecting behavior. Actually, repeated exposure to β-lactam antibiotics during infancy has been related with an increased weight in later life, and the intestinal microbiome of infants has been repeatedly reported to be affected by antibiotic use.”
The take-home message here is that we know a baby’s microbiome is altered in the short-term from GBS antibiotic exposure, and possibly the long-term as well, so why not be far more judicial in the use of antibiotics? A person’s permanent microbiota imprint is assembled in the first 3 years of life. Therefore, it simply makes sense to try to prevent interfering with this, if at all possible.
How? For one, it’s possible to do a one-hour turn around GBS test during labor. Better yet, why not at least try to prevent GBS overgrowth? It’s easy! And in the process, you develop a better gut and vaginal microbiota for you and your baby, a win-win.
cultivate a superhero vaginal microbiota as the first step
Preventing GBS and the need for antibiotics starts with optimizing your vaginal bacteria from the get-go. Read this (coming soon) post on Cultivating a Superhero Vaginal Microbiome. It’s up to you, as your pregnancy providers are probably not doing this for you. By the time you get tested for GBS, it’s late in your pregnancy (35-37 weeks), and if you are positive, you are pegged for IV antibiotics during labor.
The additional benefit of cultivating a superhero vaginal microbiota, is that it will give your baby a better chance for developing his or her own superhero microbiota, the root of a robust immune system and future metabolism.
What kind of flora does your vagina need?
Contrary to the gut microbiome, your vaginal flora should NOT be diverse! In fact, lactobacillus should be the dominant species. And the asopopholis strains are not the dominant ones. (The four dominant species are lactobacillus crispatus, iners, jensenii, and gasserii). The optimal vaginal profile is lactobacillus crispatus dominant, meaning this bacteria makes up roughly 26% of your population.
Lactobacilli species prevent unfriendly microbes like GBS from growing. A superhero vaginal microbe population is all about supporting lactobacilli. These vagina-friendly microbes make all kinds of beneficial byproducts, the top one being lactic acid – which keeps your pH an optimal 4 -4.5.(lactobacillus crispatus provides the most lactic acid, part of why it’s THE vaginal superhero). GBS can’t live in this pH, it needs a more alkaline environment.
Lactobacilli provide many other anti-GBS byproducts, and in the right numbers they provide good crowd control. A big part of GBS prevention, and treatment, is cultivating more lactobacilli. This is built into the following strategies.
Before-Pregnancy Strategy to prevent GBS
- Fix vaginal dysbiosis and build a superhero vaginal microbiota population by reading this (future) post.
- Test your vaginal pH with home test strips like these. You want it to be 4.0 – 4.5, ideal for lactobacilli and hostile to GBS. If it’s higher than 4.5, you can get a GBS test from a provider and if positive then do the Knockdown GBS Protocol below. Or, you can skip testing for GBS and do the protocol anyway.
Pregnancy strategy to prevent GBS
Why not cultivate a superb microbiota for your baby while trying to prevent GBS colonization? Here’s what you can do during pregnancy:
- Test your vaginal pH with home test strips like these. If it’s higher than 4.5, you can get a GBS test. However if it’s positive at any point during your pregnancy, labor IV antibiotics are advised. So asking for this test is a personal choice. Your provider needs to order this test for you. It’s a vaginal swab that goes to a lab for analysis. You can also skip the test and do the Knockdown GBS Protocol below.
- If your pH is an optimal 4.0 – 4.5, then just do the probiotic portion of the Knockdown GBS Protocol – #1, as prevention.
Knockdown GBS Protocol
1. Use these probiotics: Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14. These well-researched strains knock down and displace pathogenic bacteria and yeast, and have been shown to erradicate GBS. 2 caps orally at night. You can also use them vaginally, by inserting 2 capsules at night. If you do choose vaginal use, make sure you also use them orally! If not, your GI tract may still be colonized, and this can spread to your vagina. I recommend 2 caps orally and 1 vaginal (vaginal on the nights you don’t use #2, allicin, from pregnancy week 28 onwards – however sooner would only help! Brands:
2. Take lactoferrin, an ideal source of iron in pregnancy AND decreases GBS levels. 1 capsule twice daily orally, and 1 cap vaginally at night. Brands:
3. Insert allicin, from garlic. Insert 1 gelcap or 1/2 fresh garlic clove (must be cut or pierced for allicin to release) every night for 4 weeks, then once every 3 days the rest of pregnancy. Allicin brand:
- Design’s For Health Allicin (prick the gelcap before insertion)
4. Wash with thyme tea. Brew thyme tea, and use as a vaginal wash instead of soap.
There are additional home remedies, for more complex cases, or if the above don’t work for you. Happy vaginal microbes!