Systematic review and meta-analysis links higher maternal BMI to increased early-onset Group B Streptococcus disease risk

Photo by Gabriel Tovar / Unsplash

PloS one Published May 9, 2026 Medically reviewed May 12, 2026 Study authors: Graae Elisabeth Emanuel, Uldbjerg Niels, Skjøth Flemming, Bech Marie Aunskjær, Nielsen Pernille Nath… PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note association between higher maternal BMI and increased risk of early-onset Group B Streptococcus disease.

This systematic review and meta-analysis investigated the relationship between maternal prepregnancy body mass index (BMI) and the risk of early-onset Group B Streptococcus disease (EOGBS). The analysis included 3,707,047 women and examined EOGBS risk alongside intrapartum vaginal GBS colonization and rectovaginal or urinary GBS colonization before term. The authors compared women with normal BMI of 22.3 against those with higher BMI categories.

The results indicated a 2.4% increase in the odds ratio (OR) per unit increase in BMI. Specifically, the odds ratio was 1.4 (95% CI 1.1-1.6) for a BMI of 35 and 1.7 (95% CI 1.3-2.3) for a BMI of 45. The analysis identified 277,887 cases of the primary outcome and proxy outcomes. Additionally, a hazard ratio of 2.4 (95% CI 1.7-3.4) was observed for EOGBS in women with a BMI of 35.0-39.9 compared to those with normal BMI, based on 780 EOGBS cases.

The authors describe the findings as an association between maternal BMI and the risk of EOGBS. Safety data, including adverse events and discontinuations, were not reported. The study suggests that incorporating BMI into clinical assessment may improve prevention strategies for EOGBS. However, the review does not establish a causal link between maternal weight and infection risk.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJan 2026

PMID42102051

View Original Abstract ↓

BACKGROUND: Early-onset group B Streptococcus disease (EOGBS) remains a leading cause of neonatal morbidity and mortality. The incidence can be substantially reduced by intrapartum antibiotic prophylaxis in women with defined risk factors. However, the role of high prepregnancy body mass index (BMI) as a risk factor remains unclear. This systematic review and meta-analysis therefore aimed to evaluate the association between maternal BMI and the risk of EOGBS, as well as related proxy outcomes, including intrapartum vaginal GBS colonization and rectovaginal or urinary GBS colonization before term. METHODS: We systematically searched MEDLINE, Embase, and Cochrane CENTRAL on the 28th of January 2026, for studies examining the relationship between pregestational BMI and EOGBS or its proxy outcomes. Eligible studies included observational and interventional designs but not case reports and conference abstracts. Risk of bias was assessed using the QUIPS tool. Random-effects meta-regression and sensitivity analyses were performed. RESULTS: We identified 19 eligible observational studies reporting data from a total of 3,707,047 women, encompassing 277,887 cases. For the risk of EOGBS and its proxy outcomes, assuming a log-linear association, our meta-regression showed a 2.4% increase in the odds ratio (OR) per unit increase in BMI. This corresponds to an OR of 1.4 (95% CI 1.1-1.6) for a BMI of 35 and 1.7 (95% CI 1.3-2.3) for a BMI of 45, compared to a normal BMI of 22.3. One very large study on 1,971,346 live singleton births with 780 EOGBS cases, found a hazard ratio of 2.4 (95% CI 1.7-3.4) for a BMI of 35.0-39.9 compared to normal BMI (18.5-24.9). CONCLUSIONS: Although the overall association appears modest, incorporating BMI may improve prevention strategies for EOGBS .