Table 4.
Reports on unfavorable outcomes of pregnancy in patients with Lyme borreliosis during gestation.
| Author(s) and Year Type of Study | Pregnant Women | Outcome of Pregnancy | |||||
|---|---|---|---|---|---|---|---|
| Tick Bite Gestational Week of LB Onset/Diagnosis | LB Signs/LB Symptoms/Antibiotic Treatment Other Clinical Data | LB Serology | Preterm Birth: Week (Weight) | Fetal or Perinatal Death: Week (Weight) | Anomalies, Other Abnormalities | Evidence of Borrelia burgdorferi Sensu Lato Infection of Fetus or Child | |
| Schlesinger et al. 1985 Case report |
No 6–7/8 |
MEM, stiff neck/headache, malaise, arthralgias/no No |
Positive | 35 (ND) | 35 (ND) Respiratory distress, death 39 h after delivery |
Aortic valvular stenosis, patent ductus arteriosus, coarctation of aorta, tubular hypoplasia of aorta and aortic arch, endocardial fibroelastosis No |
A few spirochetes in spleen, renal tubule, bone marrow seen in paraffin block sections stained using modified Dieterle method. No evidence of inflammation, necrosis, or granuloma in any organ. Placenta not available. Later examination: immunohistochemical detection of spirochetes in cardiac tissue |
| MacDonald 1986, 1989 MacDonald et al. 1987 Retrospective analysis of perinatal autopsies 1978–1985; prospective study on perinatal deaths 1985–1988 |
No 1–2/LB not diagnosed |
EM, arthritis/no/no No |
Positive | No | At term (2500 g) Stillbirth | VSD Retardation of intrauterine growth |
Culture of spirochetes from fetal liver tissue; IFA detection of spirochetes in fetal liver, heart, adrenal glands, subarachnoid space; silver stains: spirochetes in myocardium, brain, liver, placenta. No inflammation in fetal tissues, rare plasma cells in isolated placental villi. |
| No ND/LB not diagnosed |
No/no/no Toxemia in w 17 |
Negative | 19 (514 g) | 19 (514 g) Stillbirth | ASD No |
Culture of spirochetes from fetal liver tissue; IFA detection of spirochetes in fetal liver and placenta. | |
| ND ND/LB not diagnosed |
No/arthralgias/no Toxaemia in w 22 |
Negative | 23 (490 g) | 23 (490 g) Stillbirth | Coarctation of aorta No |
Culture of spirochetes from fetal liver tissue; IFA detection of spirochetes in fetal liver and placenta. No tissue inflammation. |
|
| ND ND/LB not diagnosed |
No/no/no No |
Negative | 15 (85 g) | 15 (85 g) Stillbirth | No No |
Culture of spirochetes from fetal liver tissue; IFA detection of spirochetes in fetal liver, placentaNo tissue inflammation | |
| ND ND/LB not diagnosed |
No/no/no Vaginal bleeding in 1st trimester |
ND | No | 39 (2250 g) Respiratory distress, death in 4 h | VSD, hydrocephalus, meningomyelocele, omphalocele, spina bifida, club foot No |
Immunohistochemical detection of spirochetes in fetal tissue | |
| ND ND/LB not diagnosed |
No/no/no No |
ND | No | 40 (1950 g) Respiratory distress, death in 30 min | VSD, absent left hemidiaphragm Retardation of intrauterine growth, cardiac dysfunction |
Indirect IFA detection of spirochetal fragments in fetal tissue | |
| ND ND/LB not diagnosed |
No/no/no Vaginal bleeding in 2nd trimester |
Negative | 17 (30 g) | 17 (30 g) | Hydrocephalus No |
Indirect IFA detection of spirochetes in fetal brain | |
| ND ND/LB not diagnosed |
No/no/no Vaginal bleeding in 2nd trimester |
Negative | 16 (150 g) | 16 (150 g) | No No |
Spirochetes identified in fetal brain using immunohistochemical technique with monoclonal antibodies. No inflammation found in fetal viscera | |
| ND ND/LB not diagnosed |
No/no/no No |
ND | 12 (294 g) | 12 (294 g) | No No |
Culture of fetal viscera in BSK medium yielded B. burgdorferi and other bacteria from fetal kidney; immunohistochemistry negative for spirochetes in fetal viscera | |
| ND ND/LB not diagnosed |
No/arthralgias, myalgias, headache/no No |
Negative | 25 (ND) | 25 (ND) Intrauterine fetal death |
VSD No |
Indirect IFA detection of spirochetes in fetal tissue | |
| ND ND/LB not diagnosed |
No/no/no No |
ND | No | 40 (3746 g) | No Neonatal sepsis, respiratory distress in 1st hour of life |
Rare spirochetes found in “normal” placental villi | |
| ND ND/LB not diagnosed |
No/no/no Toxemia in w 37 |
ND | 37 (2157 g) | No | No Neonatal sepsis, respiratory distress in 1st day of life |
Many spirochetes identified in placenta using Warthin–Starry silver impregnation technique | |
| Markowitz et al. 1986 Retrospective study on 19 pregnant women with LB |
ND 6/8 |
EM, stiff neck, arthritis/headache/penicillin V 10 days No |
Positive | 20 (ND) | 20 (ND) Intrauterine fetal death |
No No |
Culture and indirect IFA negative. No inflammation found in fetal tissues. |
| ND 10/LB not diagnosed |
Facial palsy, arthritis/headache/no No |
ND | 36 (2100 g) | No | No Hyperbilirubinemia |
ND | |
| ND 20/21 |
EM, stiff neck/headache, arthralgia/ erythromycin 10 days (in w 21), penicillin V 10 days (in w 27) No |
ND | No | No | Syndactyly No |
ND | |
| ND 27/27 |
EM/no/penicillin V 10 days No |
ND | No | No | Cortical blindness Developmental delay |
ND | |
| ND 39/39 |
EM, meningitis/no/no No |
ND | No | No | No Generalized rash, hyperbilirubinemia |
ND | |
| Ciesielski et al.1987 Prospective study on 17 pregnant patients with LB |
ND ND/4 |
Not specified/not specified/data on prescribed antibiotic not available ND |
Positive | 13 (ND) | 13 (ND) Spontaneous abortion |
No No |
No evidence of borrelial infection on stains or cultures of fetal tissues. |
| ND ND/7 |
Not specified/not specified/data on prescribed antibiotic not available ND |
Positive | No | No | Syndactyly No |
ND | |
| Weber et al. 1988 Case report |
Yes 10/12 |
EM/no/penicillin 1g tid 7 days No |
Seroconversion | No | At term (3400 g) Respiratory distress, death 23 h after delivery |
No No |
Silver stain and monoclonal antibody identification of spirochetes in brain and liver. No significant inflammation found in any organ. |
| Andrásová et al. 1988 Case report |
ND ND/23 |
EM, facial palsy/arthralgias, low fever/yes (antibiotic not specified) Vaginal bleeding in 1st trimester |
Positive | 32 (1450 g) | No | No Respiratory distress, anemia |
Placenta: no spirochetes and no inflammation. |
| Nadal et al. 1989 Serologic study on 1416 pregnant women and their offspring |
Yes 1st trimester/LB not diagnosed |
EM, arthritis/no/no No |
Positive | No | No | VSD No |
ND |
| Lavoie et al. 1990 Case report |
No ND/LB not diagnosed |
No/arthralgia, malaise/no No |
Negative | No | At term (ND)Respiratory distress, myocardial dysfunction, death 8 days after delivery | No No |
Isolation of B. burgdorferi from frontal cerebral cortex; silver staining: spirochetes in brain and heart. |
| Hercogová et al. 1993, 1994 Prospective studies on 15 and 19 pregnant patients with EM |
No 6/10 |
EM/arthralgia, paresthesias/penicillin V 5 days (in w 10), penicillin V retreatment (in w 14) No |
Positive | 15 (ND) | 15 (ND) Intrauterine fetal death | No No |
Borrelia-like organism in ultrathin sections of the decidua detected using monoclonal antibody H9724 against flagellin. |
| Yes 16/18 |
EM/fatigue/ampicillin 21 days No |
Positive | 18 (ND) | 18 (ND) | Spina bifida, hydrocephalus No |
ND | |
| Yes 4/8 |
EM/no/penicillin V 24 days No |
Negative | No | No | Unclosed ductus arteriosus Botalli No |
ND | |
| Yes 25/30 |
EM/no/penicillin V 14 days No |
Negative | No | No | Cryptorchidism (established at 2 years) No |
ND | |
| ND ND/ND |
EM/ND/yes (antibiotic not specified) No |
ND | No | No | No Hypotrophia |
ND | |
| ND ND/ND |
EM/ND/yes (antibiotic not specified) No |
ND | No | No | No Hyperbilirubinemia |
ND | |
| No 18/24 |
EM/no/penicillin V 14 days, benzanthine penicillin No |
Negative | No | No | Enamel defect No |
ND | |
| No 31/33 |
EM/low fever/penicillin V 14 days No |
Positive | No | No | Enamel defect No |
ND | |
| Yes 20/23 |
EM/no/penicillin V14 days No |
Positive | No | No | No Developmental delay |
ND | |
| Williams et al. 1995 Serologic study on 5011 newborns and their mothers |
ND | ND/ND/yes (antibiotic not specified) ND |
Positive | No | No | Hypospadia No |
ND |
| Maraspin et al. 1996, 1999 Prospective cohort studies on 58 and 105 pregnant patients with EM |
Yes Before conception/6 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | 25 (610 g) | 25 (610 g)Death in few minutes | No No |
Warthin–Starry silver impregnation of fetal tissues: no spirochetes. No inflammation. Normal placenta. Chorioamnionitis and vasculitis of umbilical vessels. |
| Yes 9/10 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | 25 (450 g) | 25 (450g)Death in few minutes | No No |
Warthin–Starry silver impregnation of fetal tissues: no spirochetes. No inflammation. Normal placenta. | |
| Yes 5/5 |
EM/no/ceftriaxone 2 g i.v. 14 days Preeclampsia in w 31 |
Negative | 33 (1720 g) | No | No Respiratory distress, hyperbilirubinemia |
Not tested | |
| Yes 20/21 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | 26 (840 g) | No | No Respiratory distress, bilateral ventricular and periventricular bleeding |
Not tested | |
| Yes 23/24 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | 36 | No | No No |
Not tested | |
| Yes 15/16 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | 36 (2940 g) | No | ASD, VSD Respiratory distress, pneumothorax |
Not tested | |
| No 32/35 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | No | No | Bilateral ureteral stenosis No |
Not tested | |
| Yes 32/32 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | No | No | Vesicoureteral reflux No |
Not tested | |
| No 11/16 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | No | No | Ureteral stenosis, hydronephrosis, hydroureter dex No |
Not tested | |
| Yes 3/4 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | No | No | Syndactyly No |
Not tested | |
| No 6/7 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | 9 (ND) | 9 (ND) Missed abortion |
No No |
Not tested | |
| No 2/5 |
EM/no/ceftriaxone 2 g i.v. 14 days No |
Negative | 10 (ND) | 10 (ND) Spontaneous abortion |
No No |
Not tested | |
| Lakos et al. 2010 Clinical experiences obtained using miscellaneous approaches |
a ND 1–5/ND |
EM/ND/ND/ 4/6 pts oral antibiotic (ND on antibiotic type); 2/6 untreated |
ND | 8 (ND)—5 pts, 13 (ND)—1 pt |
8–13 (ND) Spontaneous abortion | No No |
ND |
| ND 5/ND |
EM/ND/No ND |
ND | 22 (ND) | 22 (ND) Stillbirth | No No |
ND | |
| ND 17/ND |
EM/ND/cefuroxime axetil ND |
ND | 35 (ND) | No | No No |
ND | |
| ND 13/ND |
EM/ND/ceftriaxone 2 g i.v. 15 days ND |
ND | No | No | No Small for date (2200 g at 39 w) |
ND | |
|
b ND 13–27/ND |
EM/ND/penicillin G i.v. or ceftriaxone iv ND |
ND | No | No | Cavernous hemangioma No |
ND | |
| ND/13/ND | EM/ND/ceftriaxone 2 g i.v. 15 days ND |
ND | No | No | NoHyperbilirubinemia * | ND | |
| ND/38/ND | EM/ND/erythromycin 150 mg qid 30 days ** ND |
ND | No | No | Dysplasia coxae Hyperbilirubinemia * |
ND | |
| ND 18/ND |
EM/ND/ceftriaxone 2 g i.v. 15 days ND |
ND | No | No | Dysplasia coxae No |
ND | |
| ND Before conception/ND |
EM/ND/ceftriaxone 2 g i.v. 15 days ND |
ND | No | No | Pyloric stenosis, dysplasia coxae No |
ND | |
| ND 38/ND |
EM/ND/No ND |
ND | No | No | No Papulovesicular eruption at birth |
ND | |
| ND 4/ND |
EM/ND/No ND |
ND | No | No | No Cerebral bleeding, developmental delay |
ND | |
| ND 27/ND |
EM/ND/No ND |
ND | No | No | Hypospadia, cavernous hemangioma No |
ND | |
| ND 13/ND |
EM/ND/ceftriaxone 2 g i.v. 15 days ND |
ND | No | No | Skeletal anomaly No |
ND | |
| Maraspin et al. 2011 Study on 7 pregnant patients with EM and borreliae isolated from blood |
Yes 28/28 |
EM/No/ceftriaxone 2 g i.v., 14 days No |
Negative | 36 (2500 g) | No | No No |
Not tested |
Abbreviations: LB, Lyme borreliosis; MEM, multiple erythema migrans; EM, erythema migrans; ND, no data; pt, patient; pts, patients; VSD, ventricular septum defect; w, week; ASD, atrial septum defect; IFA, immunofluorescence assay; tid, three times daily; quid, four times daily. a Summarized data for six patients with spontaneous abortion; b summarized data for three patients with cavernous hemangioma; * exchange transfusion required; ** persistent EM, therefore patient treated after delivery with ceftriaxone 2 g i.v. for 15 days.