A response to the CDC report by Placenta Services Australia

On the 30th June 2017,  the Centres for Disease Control and Infection (CDC) in America published a report linking the consumption of placenta capsules by a mother with a Group B Strep (GBS) infection in her baby(1).  As a result of this report, there has been numerous news warnings, articles, discussions within the birth and parenting worlds on social media and speculation by many.  But what do we actually know about Group B Strep and the process of placenta encapsulation?

What is Group B Strep?

Group B Streptococcus, otherwise known as Streptococcus agalactiae, is a gram-positive circular bacteria that tends to grow in pairs or short chains.  GBS is reported to be present in 15% – 40% of the population and is considered to be one of the normal bacteria.  It lives in the intestinal and genital tracts of humans usually without any harm to us (2).  It can, however, cause significant problems in newborns if they become infected.  Infection in newborns occurs from exposure to their mother’s genital tract bacteria during birth or from the amniotic fluid if the membranes rupture prematurely and the bacteria travel up into the uterus. This is known as early-onset infection.

If the baby contracts GBS after the first week of birth, it is known as late-onset infection and is believed to be transmitted from the mother through her breast milk in a rare number of cases (3), or from environmental and community sources such as hospitals and their staff (4).  Antibiotic treatment of the mother to eradicate genital tract group B strep has shown to only be effective temporarily and reinfection may occur (5)

What is Placenta Encapsulation?

Placenta encapsulation is the process of drying, crushing and putting the placenta powder into capsules for the mother to consume postnatally.  This is usually done through a business, the mother’s doula or midwife or in a few cases through family and friends.
Anybody who encapsulates should follow industry standard protocols including the use of personal protective equipment, maintenance of the cold chain, heating at correct temperatures and sanitization of all areas and equipment with the correct disinfectants.

 

What did the CDC report about placenta encapsulation and Group B Strep?

 

• The mother’s screening test for GBS at 37 weeks was negative. Your GBS status can change between when the test was taken and when you go into labour.  The test can also show false negatives. It is likely that the mother’s GBS status changed between testing and birth, or the test result was a false negative as early-onset infection comes from the mother.
• The infant was treated with antibiotics for the first infection.  There are known cases of recurrent infection of GBS after treatment (6) and the bacteria were shown to be identical in each case as was reported here by the CDC.  This raises the possibility that the first antibiotic treatment was ineffective and allowed the baby to stay infected.
• The mother’s expressed breast milk was GBS negative and serial exams did not reveal a source of the recurrent infection being transmitted from the mother.  So where did it come from? Was the mother retested?  Was the placenta swabbed before being collected? This is in conflict with the CDC statement “the final diagnosis was late-onset GBS disease attributable to high maternal colonization”
• Were hospital staff and visitors in contact with the baby tested?
• The strain of GBS isolated by the CDC, known as the ST-17 clone, has a strong association with late-onset infections in epidemiological studies due to its specific virulence factors (7). Surely this adds to the plausibility that it was a recurrent infection rather than reinfection from the mother?
• The CDC report states that “transmission from other colonized household members could not be ruled out”
• The exact temperature at which the placenta was processed was not stated. Instead, it gives a range of temperatures from the processing company’s website based on different processing methods a client could choose from.  Even if processed by using what is commonly known as the raw method, the placenta should be heated to reach a core temperature of 75℃ (8) before lowering to the ‘raw foods’ temp.  Encapsulators should also ask about infections when collecting their client’s placenta.  The client can then be counselled on appropriate processing methods if it is safe to proceed.  The placenta should not be encapsulated if infections such as chorioamnionitis are present. If the client becomes aware of an infection in herself or her baby between the time her placenta is collected and the capsules are returned, she should notify the placenta services specialist so that proper information can be given. Advice may include disposal of the prepared capsules instead of consumption.
• The CDC states that “The placenta encapsulation process does not per se eradicate infectious pathogens” yet provides no reference for this statement.  If we look at the (limited) research on placenta encapsulation, the preliminary results from Jena University Hospital (9) has found that “The preparation of placental tissue has a clear effect on the microbial contamination: dehydration causes a drastic germ reduction, steaming followed by dehydration causes an even greater reduction of microbial species. Regarding foodstuff regulations of the European Union, no “unsafe” organisms were detected in our samples.”

 

Is Placenta Encapsulation Safe?

So the CDC has reported one case of placenta consumption that coincided with a newborn sadly acquiring a disease, yet how many women have consumed their placenta with no ill effects?  Data collected by Placenta Services Australia shows that over 90% of the nearly 400 Australian women surveyed, reported no ill effects from consuming their placenta.  Those that did, listed minor side effects such as headaches, nausea or unpleasant aftertaste (10).

Finally, let’s remember that correlation (if there even is a correlation here) does not equal causation.  This report from the CDC seems to raise more questions than it does answers using placenta encapsulation as the scapegoat.  It doesn’t mean that we don’t need to take GBS seriously. Placenta Services Australia advises all members of best practice procedures if their clients return a positive GBS result.  We work hard to keep placenta encapsulation services safe for all.

 

 

What can you do to ensure a safer encapsulation experience? 

 

1. Inform yourself about the risks of GBS to you and your baby, detection, prevention during pregnancies and treatment options available.  Here are some links for further reading:

• Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives.  by Rebecca Dekker 
• More about GBS and How to Help Protect Your Baby  
• Group B Strep Resources by Sara Wickham 

2. Question your placenta services provider about their processes for transporting and storing your placenta, making your capsules and sanitising their prep area and equipment.   There is a list of questions you might like to ask in the Parent Resources  section on the Placenta Services Australia website
3.  Enforce hand washing for everyone before touching your baby or your placenta capsules.  See the video below or visit the World Health Organisation website for How To Wash Your Hands Properly
4. If you are GBS positive, steaming your placenta to a core temperature of 55℃ for 30 minutes will inactive Streptococcus agalactiae. The temperatures reached by a dehydrator alone (usually a top of 70℃) is insufficient to inactivate it.  Dry heat of 160-170 ºC for at least 1 hour is required.  The bacteria is also susceptible to 1% sodium hypochlorite (bleach) which should be used by all placenta services providers to sanitise their equipment and prep area (11)

 

References

1, Buser GL, Mató S, Zhang AY, Metcalf BJ, Beall B, Thomas AR. Notes from the Field: Late-Onset Infant Group B Streptococcus Infection Associated with Maternal Consumption of Capsules Containing Dehydrated Placenta — Oregon, 2016. MMWR Morb Mortal Wkly Rep 2017;66:677–678. DOI: http://dx.doi.org/10.15585/mmwr.mm6625a4
2. Barcaite E, Bartusevicius A, Tameliene R, Kliucinskas M, Maleckiene L, Nadisauskiene R (2008). “Prevalence of maternal group B streptococcal colonisation in European countries”. Acta Obstet Gynecol Scand. 87: 260–271.
3. Burianová I, Paulová M, Cermák P, Janota J. Group B streptococcus colonization of breast milk of group B streptococcus positive mothers. J Hum Lact. 2013 Nov;29(4):586-90. doi: 10.1177/0890334413479448. Epub 2013 Mar 22.
4. Edwards MS, Nizet V (2011). Group B streptococcal infections. Infectious Diseases of the Fetus and Newborn Infant (7th. ed.). Elsevier. pp. 419–469. ISBN 978-0-443-06839-3.
5. Streptococcus agalactiae, Pathogen Safety Data Sheet, Public Health Agency of Canada. 2011. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/streptococcus-agalactiae-eng.php
6. Edina H. Moylett, Marisol Fernandez, Marcia A. Rench, Melissa E. Hickman, Carol J. Baker; A 5-Year Review of Recurrent Group B Streptococcal Disease: Lessons from Twin Infants. Clin Infect Dis 2000; 30 (2): 282-287. doi: 10.1086/313655
7.  Six A, Joubrel C, Tazi A, Poyart C. Maternal and perinatal infections to Streptococcus agalactiae. Presse Med. 2014 Jun;43(6 Pt 1):706-14. doi: 10.1016/j.lpm.2014.04.008. Epub 2014 May 20.
8. Based on the recommended temperature to eliminate Salmonella, Campylobacter and a 6D heat process for Listeria monocytogenes. Food Standards Australia New Zealand Safe Food Australia, A Guide To The Food Safety Standards, Third Edition. November 2016. https://www.foodstandards.gov.au/publications/Documents/Safe%20Food%20Australia/Appendix%203%20-%20Limits%20for%20food%20processes.pdf
9. Sophia Johnson, Jana Pastuschek, and Prof. Dr Med. Udo Markert. A scientific approach to placenta remedies: What hormones are found in placenta tissue? April 2017. https://experiment.com/u/DKKnUQ
10. Results from PSA Data Collection. http://www.placentaservices.com.au/psa-data-collection-results.html
11. Streptococcus agalactiae, Pathogen Safety Data Sheet, Public Health Agency of Canada. 2011. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/streptococcus-agalactiae-eng.php