Proceedings in Obstetrics and Gynecology, 2010 Apr;1(1):12
Abstract:
A literature review of individuals living with or contracting
Lyme disease during pregnancy does not support an association with
congenital anomalies or adverse pregnancy outcomes provided the
patient receives adequate treatment.
Currently, the treatment of Lyme disease in pregnant women should not
differ from non-pregnant women except tetracyclines, such as
doxycycline, are contraindicated and should not be prescribed.
Case Presentation
A 20 year old female, G1P0, at 36
weeks gestation was admitted for
evaluation of possible Lyme disease.
On admission, she complained of
headache, fevers to 102F for two
weeks, and numbness, tingling, and
weakness in her right thumb, index,
and middle fingers with similar
symptoms beginning to present in her
left hand. She did not observe any
dermatologic findings such as an
erythema migrans at the site of tick
engorgement. Her possible tick
exposure was one month earlier and
she was found to be positive for Lyme
disease enzyme immunoassay
screening exam 2 weeks after
exposure. Further confirmation using
Western Blot provided a negative
result for both IgM and IgG. The
University of Iowa’s Hygienic
Laboratory’s current criteria for
diagnosing Lyme disease is 5 of 10
bands for IgG and 2 of 3 bands for
IgG. Convalescent serology was sent
6 weeks following exposure and
confirmed the negative Western blot
result suggesting that Lyme disease
was not the likely diagnosis.
Discussion
Why worry about Lyme disease in a pregnant woman?
Maternal syphilis, caused by another spirochete,
Treponema pallidum, results in congenital syphilis in the neonate
which can be characterized by lesions of the mucosal layers, maculopapular
rashes, condylomas, hepatosplenomegaly, anemia, and
osteochondritis among other possible findings.
Fortunately, while prior case reports
have suggested a possible association
between gestational borreliosis and
adverse pregnancy outcome; no
specific pattern of teratogenicity has
been demonstrated, and a causal
relationship has never been proven."
LYME DISEASE ASSOCIATED WITH
PREGNANCY
Lyme disease occurring during a
pregnancy poses no risk for feta
demise nor does it increase the
frequency of congenital anomalies i
the mother has been adequately
treated. Additionally, if a mother has
been previously diagnosed and treated
for Lyme disease there is no increased
risk for fetal manifestations.
Although several initial retrospective
case reports and small studies
published in the past suggested
congenital manifestations in infants
with mothers that contracted Lyme
disease newer prospective evidence
does not support this association.
-In a prospective study, 2000
women residing in an endemic
area had Lyme serology during
their first prenatal visit and at
delivery. Neither a history of a tick
bite nor serologic evidence of Lyme
disease during pregnancy were
associated with fetal death,
decrease in infant birth weight,
premature delivery, or congenital
malformations.”
- “In a prospective study of pregnant
women with erythema migrans
treated during pregnancy with
ceftriaxone, 51 of 58 (88 percent)
delivered normal term babies.
Among the remaining seven
pregnancies, there was one
spontaneous abortion, five
premature births, and one term
baby with a urologic defect noted at
seven months of age.”
- “A retrospective, case-control study
of 1500 children, 796 with a
congenital heart defect, showed no
link between congenital heart
disease and a history of maternal
tick bite or maternal infection within
three months of conception or
during pregnancy.”
Transplacental transmission of Lyme
disease has been described in several
case reports but due to lack of fetal
immunologic response there has been
little evidence to support an
association with congenital
Similarly, transmission of anomalies.
Lyme disease to a newborn has not
been shown to occur by breastfeeding.
Evaluation of a pregnancy that has
been complicated by Lyme disease
may include examination of the
placenta to detect Borellia
(spirochetes) within the cord vessel.
Additionally, culture,
immunohistochemistry staining, and
indirect immunofluorescence may be
of benefit in determining the presence
of Borellia during a pregnancy.
TREATMENT OF LYME DISEASE IN PREGNANCY
The optimal treatment for Lyme
disease in pregnant women has not
been defined and the Infectious
Diseases Society of America has
suggested that treatment in pregnant
women should not differ from those of
non-pregnant women with the
exception of doxycycline.
Amoxicillin and third generation cephalosporins
are safe in pregnant women. If there
are neurologic complications as seen
in late Lyme infection, IV ceftriaxone
for 14-28 days should be used. 1st-
degree AV block responds to oral
treatment while more serious
manifestations require IV treatment.
Treatment of women who are
seropositive for antibodies to B.
burgdorferi at the time of conception is
not warranted.
Conclusion
Given the probability for false positives
with the screening exam and our
patient’s negative confirmatory exam
the literature would not support giving
our patient antibiotics at this time. For
future reference, if patients are found
to be positive for Lyme disease by
Western Blot, amoxicillin 500 mg PO
TID for 14 (range 14-21 days) days is
recommended. While not first line,
macrolides can be given in penicillin-
allergic individuals. Third generation
cephalosporins could be substituted in
the event of allergy. Tetracycline and
doxycycline are not recommended as
they are contraindication during pregnancy.
