Course and Outcome of Erythema Migrans in Pregnant Women

Abstract

Information on Lyme borreliosis (LB) during pregnancy is limited. In the present study, the course and outcome of erythema migrans (EM) in 304 pregnant women, diagnosed in the period 1990–2015, was assessed and compared with that in age-matched non-pregnant women. The frequency of unfavorable outcome of pregnancies was also evaluated. The pregnant women reported constitutional symptoms less frequently than the non-pregnant women (22.4% vs. 37.2%, p < 0.001). Pregnant women diagnosed with EM later during pregnancy had a lower probability of reporting constitutional symptoms (odds ratio = 0.97 for 1-week difference in gestation week at diagnosis of EM, 95% CI: 0.94–0.99, p = 0.02). The outcome of pregnancy was unfavorable in 42/304 (13.8%) patients: preterm birth in 22/42 (52.4%), fetal/perinatal death in 10/42 (23.8%), and/or anomalies in 15/42 (35.7%). Several patients had potential explanation(s) for the unfavorable outcome. In conclusion, the course of early LB during pregnancy is milder than in age-matched non-pregnant women. The outcome of pregnancy with the treatment approach used in the present study (i.v. ceftriaxone 2 g once daily for 14 days) is favorable.

Lyme borreliosis in pregnancy and associations with parent and offspring health outcomes: An international cross-sectional survey

“…When pregnancies were classified based on the likelihood of Borrelia burgdorferi infection at the time of gestation, participants with Possible or Probable LD (including those with undiagnosed but Suspected LD) experienced much higher rates of pregnancy complications, such as extreme fatigue, joint pain, fever of unknown origin, and postpartum depression, compared to those with No Evidence of LD. These symptoms are all potentially consistent with a Lyme disease diagnosis ( 1 , 5 , 49 ) and are not necessarily a function of the pregnancy itself ( 31 ), although a comparison of symptoms before and during pregnancy in the same cohort of people would be of interest. LD-affected pregnancies were also associated with a higher rate of miscarriage, supporting an association between Lyme disease and spontaneous abortion, as previously documented ( 30 , 31 , 33 ).…”

“…These symptoms are all potentially consistent with a Lyme disease diagnosis ( 1 , 5 , 49 ) and are not necessarily a function of the pregnancy itself ( 31 ), although a comparison of symptoms before and during pregnancy in the same cohort of people would be of interest. LD-affected pregnancies were also associated with a higher rate of miscarriage, supporting an association between Lyme disease and spontaneous abortion, as previously documented ( 30 , 31 , 33 ). No significant differences in stillbirth or neonatal death rates were observed; however, these outcomes were rare ( n = 5 stillbirths and n = 2 neonatal deaths).…”

“…In some cases, fetal transmission occurred even though the parent was asymptomatic and/or tested negative for Lyme disease by standard serological assays ( 22 , 24 , 26 , 29 ). Additionally, LD-affected pregnancies have been associated with spontaneous abortion, stillbirth, premature delivery, intrauterine growth restriction, and neonatal death ( 30 , 31 ), as well as a variety of neonatal conditions following a live birth, such as hyperbilirubinemia, hypotonia, cardiovascular and urinary tract defects, orthopedic and neurological abnormalities, respiratory distress, and rash ( 23 , 24 , 27 – 29 , 32 ). Fortunately, there is also evidence to suggest that treating the parent for Lyme disease prior to or during pregnancy may reduce the frequency of these adverse outcomes ( 30 , 33 ).…”

Comparison of Lyme Disease in the United States and Europe

“…One difference is that phenoxymethylpenicillin (penicillin V) is recommended for treatment of erythema migrans and borrelial lymphocytoma by some of the guidelines in Europe but is not part of the treatment recommendations in the United States (1,44,45). Another difference is the recommendation by some authorities in Europe to use intravenous ceftriaxone to treat erythema migrans, as well as other manifestations of Lyme disease, in pregnant women; whereas in the United States, antimicrobial drug treatment of Lyme disease for pregnant women is the same as that for nonpregnant patients, except that doxycycline is not recommended for pregnant women (1,44,46). Postexposure antimicrobial prophylaxis with a single 200-mg dose of doxycycline has been shown to reduce the risk for Lyme disease after an I. scapularis tick bite and is recommended for consideration for tick bite prophylaxis in the United States (44).…”

Borreliosis in pregnant women - the current state of knowledge

“…Jak wynika z badań, u dużej części ciężarnych z nieleczoną boreliozą dochodzi do poronienia bądź przedwczesnego porodu, a niekiedy urodzenia martwego dziecka. Za podstawową przyczynę utraty ciąży uznaje się występujące zakażenie wewnątrzmaciczne [6,[27][28][29].…”