Category: Lyme Transmission and Prevention
Should I be concerned about Lyme disease if I am pregnant?
The simplest answer to this question is that a woman who contracts Lyme disease during her pregnancy is at risk of transferring infection to her fetus. These women should receive antibiotic treatment as soon as possible; it might also be wise after childbirth to have the placenta examined histologically and for spirochetes. Antibiotics that may be used include amoxicillin or penicillin. Pregnant women in Lyme endemic areas should be particularly vigilant about avoiding areas with high tick exposure.
Less clear is what to recommend to women who contracted Lyme disease prior to pregnancy and who have been treated adequately. Research suggests that these women appear to be at no increased risk of adverse fetal outcomes than women who did not have Lyme disease. That is good news, of course. This question needs to be studied more carefully with larger sample sizes.
Research reports indicate the following:
a. Transplacental transmission of Bb (the agent of Lyme Disease) has been documented in a woman who did not receive antibiotic therapy. The mother developed Lyme disease during the first trimester of pregnancy and her infant died of congenital heart disease during the first week of life. Histologic examination of autopsy material showed the Lyme disease spirochete in the spleen, kidneys, and bone marrow.
b. Dr. Alan MacDonald in 1986 reported on 4 cases of aborted fetuses in which Borrelia spirochetes were cultured from fetal liver. In one case, there was evidence of positive fluorescence after a monoclonal mouse antibody specific for Bb was applied to the tissue.
c. In 1986, Drs. Markowitz, Steere, Benach, Slade and Broome reported on 19 cases of Lyme disease during pregnancy in which 13 received antibiotic therapy. Adverse outcomes occurred in 5 of the 19 pregnancies; the varied outcomes could not be definitely linked to Lyme disease.
d. In 1989, Dr Olesk and others reported that of 143 pregnant women who had been serum tested for Lyme disease, only one of the 12 patients who miscarried had tested positive -- this was consistent with the conclusion that a positive serum Lyme test does not increase risk of miscarriage.
e. In 1993, Drs. Strobino, Williams, and others reported on a study of prenatal exposure to Lyme Disease in which seroconversion was assessed at the time of the first visit to delivery. Of 1,290 women tested twice, only one seroconverted and this woman had a healthy child. This study found that neither the diagnosis of Lyme disease in the past nor living in a highly endemic area were associated with fetal death, low birth weight, or congenital malformations.
f. In 1995, Dr. Williams, Strobino and others reported on an umbilical cord serologic study of 5,000 babies: one cohort from an endemic area and one from a non-endemic area. Infants were followed up to 6 months of age. Mothers of infants in the endemic area were 5-20 times more likely to have been exposed to B.Burgdorferi in the past compared to mothers of infants in the non-endemic area. Within the endemic cohort, there were no differences in the rate of major or minor malformations or birth weight by maternal LD history or cord blood serology.
g. In 1999, Drs. Strobino, Abid and Gewitz reported on a case-control study in a Lyme endemic area designed to specifically address the risks of congenital heart disease and maternal Lyme disease. Cases were comprised of children with congenital heart defects and controls were selected from among children seen at the same pediatric cardiology service with no abnormalities. There was no association between congenital heart disease and maternal tick bite, or maternal Lyme disease within 3 months of conception or during pregnancy.
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