Association of Obesity With Maternal and Cord Blood Penicillin Levels in Women With Group B Streptococcus Colonization

Obstet Gynecol. 2020 Oct;136(4):756-764. doi: 10.1097/AOG.0000000000004020.


Objective: To compare maternal and cord blood penicillin concentrations in women with and without obesity who are receiving intrapartum group B streptococcus (GBS) prophylaxis.

Methods: We performed a prospective cohort study of term women receiving intrapartum penicillin prophylaxis for GBS colonization (determined by antenatal rectovaginal culture). The following outcomes were compared between obese (body mass index [BMI] 35 or higher at delivery) and nonobese (BMI less than 30 at delivery) groups: penicillin concentration in maternal blood (after two penicillin doses) and umbilical cord blood, GBS rectovaginal colonization status on admission and after two completed doses, and neonatal GBS colonization (using a postnatal ear swab). Fifty-five women were needed to detect a 0.75 SD difference in cord blood penicillin concentrations.

Results: Fifty-five women were enrolled and had all specimens collected; 49 had complete data for analysis (obese n=25, nonobese n=24). There was no difference in the median maternal penicillin concentration between groups (obese 4.2 micrograms/mL vs nonobese 4.0 micrograms/mL, P=.58). There was, however, a 60% lower median cord blood penicillin concentration in the obese compared with the nonobese group (2.7 micrograms/mL vs 6.7 micrograms/mL, respectively, P<.01), with no significant difference in time from last penicillin dose to delivery (obese 2.9 hours vs nonobese 1.7 hours, P=.07). The difference in cord blood concentrations remained significant after adjustment for nulliparity, hypertensive disorders, and time from last penicillin dose to delivery. Only 59.6% of women tested positive for GBS by rectovaginal culture on admission (obese 60.9% vs nonobese 58.3%, P=.86).

Conclusion: The median cord blood penicillin concentration was 60% lower in neonates born to women with obesity compared with those born to women without obesity. However, all concentrations exceeded the minimum inhibitory concentration. Maternal penicillin levels were not significantly different between groups. More than 40% of women who previously tested positive for GBS by antenatal culture tested negative for GBS on admission for delivery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / blood
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis / methods
  • Body Mass Index
  • Drug Monitoring / methods
  • Female
  • Fetal Blood / chemistry*
  • Humans
  • Infant, Newborn
  • Male
  • Neonatal Screening / methods*
  • Obesity* / blood
  • Obesity* / complications
  • Obesity* / diagnosis
  • Outcome and Process Assessment, Health Care
  • Penicillins* / blood
  • Penicillins* / therapeutic use
  • Pregnancy
  • Pregnancy Complications, Infectious* / blood
  • Pregnancy Complications, Infectious* / drug therapy
  • Rectum / microbiology
  • Streptococcal Infections* / blood
  • Streptococcal Infections* / complications
  • Streptococcal Infections* / drug therapy
  • Streptococcus agalactiae / isolation & purification*
  • Vagina / microbiology


  • Anti-Bacterial Agents
  • Penicillins