http://www.ijidonline.com/article/PIIS1 ... 2/abstract
There is disagreement regarding whether Lyme borreliosis is associated with adverse pregnancy outcome.
We performed a review of the data from 95 women with Lyme borreliosis during pregnancy, evaluated at the Center for Tick-borne Diseases, Budapest over the past 22 years
Treatment was administered parenterally to 66 (69.5%) women and orally to 19 (20%). Infection remained untreated in 10 (10.5%) pregnancies. Adverse outcomes were seen in 8/66 (12.1%) parentally treated women, 6/19 (31.6%) orally treated women, and 6/10 (60%) untreated women. In comparison to patients treated with antibiotics, untreated women had a significantly higher risk of adverse pregnancy outcome (odds ratio (OR) 7.61, p=0.004). While mothers treated orally had an increased chance (OR 3.35) of having an adverse outcome compared to those treated parenterally, this difference was not statistically significant (p=0.052). Erythema migrans did not resolve by the end of the first antibiotic course in 17 patients. Adverse pregnancy outcome was more frequent among these ‘slow responder’ mothers (OR 2.69), but this was not statistically significant (p=0.1425) . Loss of the pregnancy (n=7) and cavernous hemangioma (n=4) were the most prevalent adverse outcomes in our series. The other complications were heterogeneous.
Our results indicate that an untreated maternal Borrelia burgdorferi s.l. infection may be associated with an adverse outcome, although bacterial invasion of the fetus cannot be proven. It appears that a specific syndrome representing ‘congenital Lyme borreliosis’ is unlikely.
It appears that a specific syndrome representing ‘congenital
Lyme borreliosis’ is unlikely. However, spontaneous abortion,
stillbirth, and preterm birth have frequently been identified in
other published studies1,2,4 and were also found in our series. The
miscarriage rate in our cohort is much lower than the average in
Pregnancy loss was significantly more frequent among
untreated patients than among the parenterally treated women in
our study population. We frequently observed hemangioma, a
hitherto unpublished symptom coincidental with maternal
Borrelia infection. In contrast, cardiac abnormalities were not
found; these have been the most frequently published consequence
of maternal Lyme borreliosis in other reports.3,7,8,22 We
found some of the symptoms mentioned in other papers, such as
hyperbilirubinemia,23 cerebral bleeding,24 generalized rash,2 and
congenital urologic malformations.4,7 One of the infants in the
present study had pyloric stenosis, and Strobino et al.7 have
described a newborn with gastric reflux.
Placentas and offspring were not tested for Borrelia by PCR or
culture in our study. Therefore, it cannot be concluded that the
adverse outcomes were a result of a Borrelia invasion of the fetus or
placenta. The adverse outcome may have been a consequence of
damage to the placenta or a maternal reaction to the infection.
There are animal studies that have demonstrated maternal–fetal
transmission, but others have not supported this conclusion