Lyme Disease in Pregnancy
Lyme disease is the most common vector borne disease in the United States. A number of other spirochetal diseases, if contracted during pregnancy, have been shown to cause harm to the fetus.(Walsh, 2006) This gives reason to examine and review the known effects of Gestational Borreliosis as well as discuss the probability of transmission and outcome of a mother and baby who has been diagnosed with Lyme Disease before or during pregnancy. This paper will give a brief background and description of Lyme Disease as well as review some documented cases of correlation. I will also include results of a study made in Hungary on the effects of gestational borreliosis. Signs and symptoms of the infection will be analyzed. Prevention and treatment methods, including antibiotic and alternatives will be discussed.
Lyme disease is caused by a particular kind of bacterium-a spirochete. Spirochete literally means “coiled hair”. There are many types of spirochetes as well as varieties of Lyme disease. Borrelia burgdorferi is considered to be the primary agent of Lyme borreliosis in the United States. Lyme spirochetes resemble a corkscrew-shaped worm and literally “screw” or “worm” their way through tissues they wish to colonize. This kind of mobility allows them to get very deep into tissues and makes them hard to diagnose and kill. ( Buhner, 2005) This organism is most commonly transmitted to humans by the bite of a deer tick known as Ixodes dammini. However there are at least four other types of ticks in North America that are also capable of being vectors of this disease(Amstey, 1998). Numerous other co-infections may also be transmitted by the same tick. While Lyme borreliosis is the most common and understood initial infection, all co-infections should also be taken into consideration in treatment. Lyme spirochetes are passed not only through tick bites but also through other mechanisms. “ Once they infect people they can be found in breast milk, in tears, in semen, and in urine. Babies have been infected through their mothers while in the womb.” (Buhner,2005) Regrettably, little research has been done on the amount of transmission through these kinds of media, the focus has been on ticks. (Buhner,2005)
Lyme was first named and diagnosed during an outbreak in the mid 1970s in the Lyme and Old Lyme areas of Connecticut. Lyme Disease is most commonly found in the Northeastern section of the United States but is becoming more and more frequent in the west as well.
When bitten by a tick it is very important to know the signs and proper precautions to take in order to diagnose borreliosis in its early stages. The first and most common symptom is erythema chronicum migrans (ECM) which is an dermatological condition that may appear around the bitten area. This is the commonly known “bulls eye” rash that most know as a sign of an infected tick. This lasts for a matter of days to a couple weeks and then subsides. This ECM rash has long been considered one of the primary markers for Lyme infection. However, this is not a reliable diagnostic indicator for all people as only about a third (37%) who are infected have this as a symptom. When ECM rash does occur it is nearly always a confirmatory diagnosis for Lyme infection (Buhner,2005). If it is not treated at this first stage the systemic manifestations of the disease develop: a flu like syndrome with headache, photo phobia, and dysesthesias followed by acute and chronic neurologic, arthritic and cardiac disease ( Amstey, 1998).
There are considered to be three stages of Lyme disease: early , early-disseminated, and late. Early Lyme disease is considered to occur in the days or weeks after initial infection, early-disseminated to occur weeks to months after infection, and late to occur months to years after initial infection. Late stage is considered to be when the disease has become chronic. The reason these stages have been delineated is that treatment is much more effective in early stages of the disease and (sometimes) symptoms are very different. As time goes by the organisms are able to adapt themselves to the person they are in and adjust to the immune response in that individual. Therefore the later treatment occurs the harder it is to get rid of the disease ( Buhner, 2005).
The ideal diagnostic approach is to save the tick found on a patients body and have the tick tested for the spirochete. The next best approach is to be aware of and recognize the ECM rash (Amstey, 1998).Laboratory studies are likely to be negative at this early stage in the infection. Only in about 10% of people with ECM can the spirochete be detected in the bloodstream. Early-disseminated/Late symptoms can vary greatly but the most common are: pain and inflammation in joints (especially knees), continual low-grade fever, high fever, chills or sweating, general flu like symptoms, frequent headaches and neck stiffness, Bell’s Palsy, disorientation, blurred vision and or light sensitivity, swollen glands, upset stomach or abdominal pain, sudden hearing loss, buzzing or ringing in ears and sound sensitivity, as well as many others (Buhner, 2005). When the clinical picture is not diagnostic serological testing is required. Enzyme-linked immunosorbent assay (ELISA) is the most commonly used initial test. ELISA essentially tests blood serum for the presence of antibodies to borrelia organisms, however there is a high rate of false positives and negatives. Results should be confirmed with the more specific Western Blot analysis. This test indicates the presence of antibodies that are produced in response to infection. However these tests do not make the diagnosis of active Lyme disease as the antibodies persist long after the disease is treated. In conclusion of these facts, the diagnosis of Lyme disease should never be made on laboratory evidence alone. The diagnosis should be based upon the clinical likelihood , with serological testing used for conformation (Walsh,2006).
The effects of Lyme Disease when contracted during pregnancy vary greatly in each case study. I will describe a few documented reports discussed in an Obstetrical and Gynecological Survey CME Review Article.
In 1985 the first well documented case of transplacental transmission of B.burgdorferi was reported. The women developed an EM rash in the first trimester and did not receive antibiotics. Her infant was born at 35 weeks and died at 39 hours of age. Postmortem examination revealed multiple cardiac defects and spirochetes present in the infant’s spleen, kidneys, bone marrow and later the myocardium. In a later publication by the same author the case of a 23 year old woman who presented with EM and aseptic meningitis in the second trimester was reported. She was treated with penicillin, and a healthy infant was delivered at term with no evidence of spirochetes on placental examination.
In 1988 the first adverse pregnancy outcome associated with Lyme disease, despite antibiotic treatment was reported. The woman in this case received seven days of oral penicillin, after developing EM in the first trimester. Her infant was delivered at term by vacuum extraction and died within the first day of life from acute respiratory distress. B. burgdorferi was identified in the fetal brain and liver. The diagnosis was that of respiratory failure as a consequence of “perinatal brain damage.”
(Walsh, 2007) Other reports show yet more inconclusive outcomes and varying results of patients treated with antibiotics. However studies do show that when left untreated the chance of adverse pregnancy outcome to be significantly higher (Lakos,2009) Although the population studies are quite large, the total number of women reported in the literature with onset of Lyme in pregnancy are still relatively small. From the evidence available, it is reasonable to conclude that there is no distinct pattern of teratogenicity from Lyme infection(Walsh, 2007). However expectant mothers who contract Lyme during pregnancy, especially during the first and second trimesters, should seriously examine all methods of treatment and take the disease seriously as untreated results are definitively grim.
In 2009 The International Journal of Infectious Diseases did a study on Maternal Lyme borreliosis and pregnancy outcome. The study took place in Hungary and included 95 expectant mothers all diagnosed with Lymes Disease. The interval of which the mother was infected during pregnancy varied widely between the 1st and 280th day of gestation. All of the women were Caucasian and did not use illicit drugs, smoke cigarettes or regularly drink alcohol during the pregnancy. The average age of the women was 29.7. Fifty-nine mothers recognized a tick bite and 49 were serologically positive for Borrelia antibody. Some of the women were treated with antibiotics either parenterally or orally. Some were left untreated. The results showed patients had a 60% higher likelihood of an adverse pregnancy outcome when left untreated. The results of a healthy newborn was also confirmed to be 40% more likely if treated with antibiotics prenatally. Some of the adverse reactions seen in this study were spontaneous abortion, stillbirth, premature birth, small for dates, cavernous hemangioma, neonatal jaundice requiring exchange transfusion, dysplasia coxae(Hip dysplasia), pyloric stenosis (GI disorder), papulovesicular(dermalogical) eruption at birth, cerebral bleeding, muscular hypotonicity, hypospadias(abnormally placed urinary meatus), and skeletal anomaly. Spontaneous abortion most often occurred when the infection was acquired in the first weeks of pregnancy. All newborns born to mothers who were positive for borreliosis antibodies at delivery were also positive. The IgG reaction fo the newborns mirrored the immunoblot pattern of their mothers, suggesting that these antibodies were of maternal origin. The findings of this study demonstrate a statistically significant association between untreated Lyme borreliosisand adverse pregnancy outcome. It appears that there is not a specific syndrome associated with maternal Lyme disease. However, spontaneous abortion, stillbirth, and preterm birth have frequently been identified in other published studies (Lakos 2009).
As discussed earlier in this paper, proper and prompt diagnosis of Lyme disease is the best way to diagnose the infection. While saving the tick and having it tested is optimal it is not always possible. If the ECM rash is present, Lyme disease may be diagnosed on clinical grounds alone. If not, diagnostic testing may result in false positives or negatives (Walsh, 2007). Without certain diagnosis choosing a treatment method can be a difficult decision, especially when pregnant.
The best option is of course, PREVENTION. This also can be an impossible method since avoidance of exposure to ticks is the best way to prevent being bitten by one. When pregnant, extra precautions should be taken when out in nature. Late spring and early summer are peak tick seasons. Wearing long pants and long sleeves as well as thorough, daily tick checks after any outdoor exposure is an important prevention routine. Astragalus herb can be taken in peak season or all year in a lyme endemic area as a immune protector against possible infection.
If bitten prompt removal is essential. If a tick is found and removed less than 24 hours after attachment infection is usually terminated (Feder,2008). Deer ticks are extremely small and hard to spot until they are engorged with blood so a shower after outdoor activities can ensure cleanliness before they bite. If bitten, prompt removal as well as saving the tick is the optimal precaution to take. Careful monitoring of the bite site for abnormalities or ECM rash is advised for a week or two. If anything of concern arises it is best to take the tick in to be tested for B. burgodorferi as well as seek medical advice concerning the symptoms. When removing a tick it is important to use tweezers or a “tick key” to ensure you get the whole tick removed without leaving the head inside. Dogs and other pets should also be routinely checked. Do your best to “tick proof” your yard. Clearing brush and leaves and keeping wood piles in sunny areas will prevent possible tick habitats. Tick repellants can also be helpful but precautions should be taken since some chemicals used could also be teterogenic during pregnancy. For early-stage disease including symptoms of a ECM (bulls eye) rash, antibiotic treatment is usually recommended even during pregnancy. Amoxicillin, penicillin, or erythromycin taken orally for 10-28 days is the usual medical recommendation. Tetracyclines are contraindicated in children and pregnant women (Conaty,1996). Later-stage disease (and some believe any stage in pregnancy) recommends IV antibiotics.
“ Mothers who develop Lyme disease in pregnancy can be reassured that fetal B burgodorferi. infection never has occurred if the mother is treated adequately” (Feder, 2008). What kind of treatment is adequate can be difficult to discern. The decision to treat the baby further if the mother has just started treatment or has not completed treatment depends on many factors and should be made with the help of a pediatric infectious disease specialist (Amstey, 1997).
The treatment for killing Lyme infection by technological medicine is primarily limited to killing spirochetes. This is a common limitation of western medicine. Lyme disease is very complex as is a human being and limiting focus to only killing the bacteria is often not a complete or sufficient treatment method. Alternative medicine around Lyme disease tends to also focus on immune modulation and support, collagenous tissue support, and symptomatic help. Non pharmaceutical approaches can also act to kill microorganisms and can be surprisingly effective.
With Lyme infection everything is experimental. Antibiotics do work for many people but they do not work for all or even a large majority of those infected. The complexity of the organism’s response and its ability to hide in the body or to alter its form to resist antibiotic regimens make antibiotics useful but not a cure-all by any means. At this point in time antibiotics are the most understood aniti-spirochetals because this is where nearly all the research has occurred.
Herbal medicines are especially good at dealing with immune enhancement and response to the infection. Also, while many of the specific symptoms that accompany Lyme infection will subside with a competent course of antibiotics, three aspects of Lyme symptoms and antibiotic treatment are important to keep in mind. The first is that during the thirty days or more of an antibiotic regimen symptoms may persist or even worsen. Second, for some people multiple antibiotic regimens or even lengthy, extended, antibiotic treatments are necessary. Lyme symptoms are often the problem for these people and so they keep coming for more antibiotics. And third, for some people antibiotics do not work. Either the symptoms fail to resolve or only partially resolve (Buhner, 2005).
“Herbal and supplement regimens can be designed for each of these groups to help protect the sites where symptoms are occurring, to reduce symptoms, and to alleviate the suffering that accompanies Lyme infection.” (Buhner, 2005). For example, devils claw herb is exceptional for treating pain of Lyme arthritis and stephania root for reducing edema. The use of probiotics to help maintain bowel health or to correct irregularities, such as candida overgrowth (especially during pregnancy) after extended antibiotic regimens, is essential (Buhner, 2005). Stephen Harrod Buhner discusses a “Core Protocol” in the natural healing of Lyme Borreliosis in his book “Healing Lyme”. He also states that we are only at the beginning of our knowledge of this disease and posts updates and information on his website at www.gaianstudies.org. Buhner states that a basic herbal regimen can be used along with antibiotic therapy and will increase the positive outcomes from antibiotics considerably. This “core protocol” is a way to create a full and comprehensive treatment plan. If antibiotics have not worked or the patient does not wish to use them, this protocol can help them develop a treatment regimen. Buhner’s core protocol consists of three main herbs and two supplemental herbs- andrographis (Andrographis paniculata), Japanese knotweed (Polygonum cuspidatum), and cat’s claw (Uncaria tomentosa) as well as astragalus (Astragalus membranaceus)and smilax (Smilaxrotundifolia L.). These herbs will significantly lower or eliminate spirochete loads on the body (including the central nervous system), raise immune function in ways that will specifically empower the body to respond to borrelia infection (such as raising CD57 white blood counts), and significantly alleviate the primary symptoms of Lyme disease. Buhners book describes the protocol in his book based on stage and symptom of the infection and give appropriate doses and recommendations.
A less known, valid, non-pharmaceutical option for this illness is Rife Machine treatments. Rife machines are electrical therapy machines that treat and kill infections of many kinds. The effectiveness of electromagnetic frequencies against Lyme Disease was tested and documented throughout the 1980′s by a researcher and manufacturing engineer named Doug MacLean. He was a victim of Lyme Disease and when antibiotics failed him he began researching Royal Raymond Rife’s discoveries of nearly fifty years earlier.
Rifes studies proved that electromagnetic frequencies have the ability to disable microorganisms. However it wasn’t until Doug’s research that there was objective proof that Lyme Disease spirochetes could be destroyed with electromagnetic frequencies. Inadvertently through his studies he was exposed to the treatment frequencies giving himself accidental treatment. Doug went on to invent a modern rife machine that he used to attain complete remission from his Lyme disease. In 2001 he had been symptom free and antibiotic free for more than 15years. (Rosner ,2001)
So if these Rife treatments are valid and able to cure Lyme Disease why are doctors not using them? According to a survey conducted by the Lyme and rife online discussion group asking patients if their doctors know about rife machines, 39% of LLMDs (Lyme Literate MD) know about them and of those 39%, 77% suggest they are helpful for treating Lyme disease. The world wide rife machine community is expansive. Some countries consider rife machine technology to be a valid form of medical care. In South Africa and Europe rife machines are legally licensed as a Class II medical machine for use by medical practitioners and their practices. In the U.S. Rife machine technology has been lumped into the category of “alternative medicine”. (Rosner, 2001)
Since Lyme disease is the fastest growing infectious disease in the United States we must be informed and ready to act if it enters our paths. Prevention and precaution are advised for all who do not already have Lyme disease. When pregnant, it is especially important to be well educated and up to date on the status of Lyme in your area. Knowing what action to take and acting promptly in the event of contraction could save your client, friend, your self, or your baby. If you are already a victim of Lyme, knowing your options and utilizing all the information and resources available can aid in your healing and recovery.
There is still much to be learned about Lyme disease. After my research I am still left with questions un-answered. For example, what is the likelihood of the disease spreading if the mother was diagnosed with Lyme and it is dormant when she becomes pregnant? Will Lyme cross the placenta if it is dormant? While everything is still experimental with this disease those effected will have to be patient and willing to work to find answers to the questions.
- Lakos Andras, Solymosi Norbert. 2009. Maternal Lyme borreliosis and pregnancy outcome. International Journal of Infectious Disease;14, e494-e498.
- Colin A., Walsh MB, Elizabeth W., Mayer MD, Laxmi V. Baxi MD.2006. Lyme Disease in Pregnancy: Case report and review of the literature. CME Review Article; 62, 42-50.
- Amstey Marvin MD. 1998. Lyme disease in pregnancy. Contemporary OB/GYN; 31-39.
- Ajina Claire. 2013. Understanding Lyme Disease in School Age Children. Humboldt State University-A Poster Presentation, NASP Annual Convention.
- Feder Henery Jr. MD. 2008. Lyme Disease in Children. Infectious Disease Clinics of North America; 22, 315-326.
- Conaty Susan, Dattwyler Raymond MD. 1996. Lyme Disease: 10 Questions Physicians Often Ask. Consultant; 2252-2263.
- Quintana Heather. 2012. In the Lyme Light. www.VibrantLife.com. 28-31.
- Buhner, Stephen. Healing Lyme. Vermont: Raven Press, 2005.