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Lyme & Other TBD Treatment in Pregnancy: New guidance

In a recently published review article,* authors provide a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections, including several tick-borne diseases (Lyme disease, ehrlichiosis, human granulocytic anaplasmosis, human monocytic ehrlichiosis, babesiosis, and Rocky Mountain spotted fever). This review provides guidance to clinicians based on the most recently published evidence-based research and expert recommendations.

The review  included a search of MEDLINE (inception to March 2021); clinical practice guidelines (both national and international); the CDC website; and additional references from bibliographies of noteworthy articles. The review also provides a list of medications on the WHO Essential Medications List that are used to treat the above infections (*Alyssa P. Gould et al., Drugs in Context-peer reviewed).

NOTE:  The information presented is for informational purposes only. The LDA does not give medical or legal advice. Any information on the site should not be used to take the place of advice from your personal physician or from any other professional. Any health care or legal information on the website is attributed to the professional(s) who wrote the information and is not necessarily endorsed by the Lyme Disease Association. Links to other sites are provided for ease of research, and information on those sites is the opinion of those who publish the sites and is not necessarily that of the LDA. The LDA does not endorse professionals, products or services.

 

A summary of key treatment recommendations from the review article for several tick-borne diseases during pregnancy are as follows:

Lyme disease:
  • Treatment of gestational Lyme disease is essential to reduce adverse outcomes in pregnancy. The data shows adverse outcomes in treated pregnancy is (11–16%) compared to untreated disease (50–60%).
  • Doxycycline should not routinely be used in pregnancy for Lyme disease in order to avoid adverse side effects including transient suppression of bone growth and staining of developing teeth, especially with proven alternatives.
  • Amoxicillin is the preferred treatment in the absence of neurological manifestations or atrioventricular heart block. 
  • Ceftriaxone is typically reserved for patients with severe neurological or cardiac manifestations. 
  • One study noted a non-significant increase in adverse pregnancy outcomes, such as pregnancy loss, among orally treated (31.6%) compared to parenterally treated (12.1%) pregnant patients.
  • Alternative oral therapy is cefuroxime axetil and parenteral therapies include penicillin G or cefotaxime.
  • Late Lyme disease (often manifesting as Lyme arthritis) may be managed with oral or parenteral β-lactams. 
Ehrlichiosis & Anaplasmosis:
  • If infections with anaplasmosis or ehrlichiosis is suspected, treatment should be initiated due to the likelihood of complications and potential for vertical transmission of disease. 
  • Rifampin has shown in vitro activity against ehrlichia and has been used successfully in limited case reports of pregnant women with anaplasmosis.
  • Doxycycline has been used successfully to treat ehrlichiosis.
  • Due to a lack of data, these pregnant patients should be closely monitored for resolution of disease.
  • The addition of amoxicillin or cefuroxime is suggested if coinfection with Lyme disease is suspected, as rifampin does not have activity against B. burgdorferi.
Babesiosis:
  • Patients with suspected babesiosis should be treated due to potential complications, including possible vertical transmission to the fetus.
  • Combination therapy is preferred with clindamycin plus quinine. 
  • Longer treatment courses or retreatment may be needed in cases with symptoms and/or parasitaemia persisting >3 months. Resolution of parasitaemia should be used to determine treatment course.
Rocky Mountain spotted fever (RMSF):
  • RMSF cases are associated with poor outcomes for the fetus, regardless of the treatment.
  • Prevention is crucial for pregnant patients, and treatment should be provided within 3–5 days of exposure.
  • Doxycycline is the preferred therapy. Treatment course is typically 5–7 days or 3 days after fever resolution.
  • Chloramphenicol is a proposed alternative treatment; but there are concerns for significant adverse effects, including myelosuppression, aplastic anaemia, and grey baby syndrome, specifically at or near birth, and it is associated with higher mortality in RMSF. (chloramphenicol is not available orally in the US).

Read the full review article here

Read other LDA articles regarding treatment here




Sue Faber, RN, BScN Guest Blog – Lyme & Pregnancy

May Awareness LDA Guest Blogger

SueFaberbyStef&EthanSue Faber is a Registered Nurse (BScN) and Co-founder and President of LymeHope, a not-for-profit organization in Canada.  Sue’s specific area of expertise and research is in the compilation and analysis of the literature that exists on maternal-fetal transmission of Lyme and congenital Lyme borreliosis; amplifying, supporting and powering urgent research initiatives to investigate this alternate mode of transmission with the ultimate goal of opening new doors to ensure that children and families affected are able to access appropriate care, treatment, and support.

In 2018, Sue co-authored a nursing resolution for the Registered Nurses Association of Ontario – based on the needs and voiced concerns of Canadians  with Lyme disease coast to coast.  ‘Patient First Treatment for Ontarians with Lyme Disease’– which was passed at the annual 2018 AGM in Toronto.    Sue was awarded the RNAO HUB Fellowship award in 2019.  Sue is honored to be an advisor to the newly formed advocacy group Mothers Against Lyme and has spoken at various conferences on maternal-fetal transmission of Lyme including ILADS (2019), LymeMIND (2019, 2020), NE Ohio Lyme Symposium,  Lyme WNY Symposium and Target Lyme (Ontario).   Sue is honored to collaborate with colleagues from McMaster Midwifery Research Centre in new ground-breaking research on Lyme and Pregnancy.

Sue is firmly committed to transparent and collaborative partnerships with governments, academia, research institutions, healthcare colleagues, and industry stakeholders, to collectively identify challenges, knowledge gaps, and fresh opportunities, to examine and develop transformative health policy, best practice guidelines, and research priorities, which are anchored in patient voice, values, and priorities.

Lyme and Pregnancy:  A Hopeful and Tangible Path Forward

My History  I’ll never forget the day at the end of January 2017 that I received an official letter from my local public health department.  The letter was in response to my requests for a meeting with senior management, to alert them to positive test results for Lyme disease for both myself and one of my daughters and to discuss my concerns that I may have transmitted this infection to her in-utero.   A year earlier I had tested two-tier positive for a European strain of Lyme in Canada – after years of complex multi-system medical symptoms which were fully investigated by multiple medical specialists, without any definitive answers.   I had no recall of a tick bite or an erythema migrans rash and thus tickborne disease had never been considered as a differential diagnosis by my medical team.  As a trained ER nurse, I knew nothing about Lyme disease. 

It was a stroke of luck that my primary doctor decided to test me for Lyme after every other possible diagnosis had been ruled out.  The test was positive. My eventual diagnosis of late-stage disseminated Lyme disease by a Canadian infectious disease physician was initially a relief as I now had a name to my illness and what I thought would be a defined path to recovery and healing.  Little did I know that this diagnosis would be the start of a journey into advocacy – one which I have likened to climbing up a steep mountain – without a map or guide – trusting and hoping that one day, I’d make it to the top.

As a Registered Nurse I am extensively trained in evidence-based practice and problem-based learning which has put me in good stead after receiving my Lyme disease diagnosis. I started delving into the published literature on Lyme disease and soon discovered the multi-system complexities of Lyme disease with some researchers identifying striking similarities to syphilis. [i] [ii]  Soon thereafter, I discovered the first published case report that Lyme disease could be transmitted from a mother to her baby in-utero in a paper titled ‘Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi’.[iii]  My heart started to race, I was nauseated and tears started to fall down my cheeks – could this mean that my precious daughters were also impacted?   Like most other aspects of Lyme, I would soon learn that the issue of maternal-fetal transmission was very controversial.

The onset of my symptoms was gradual and predated all of my pregnancies including one first trimester pregnancy loss.  All my daughters had struggled with varying complex medical issues from birth which included jaundice, severe colic, high fevers, myocarditis, atypical seizures, severe OCD, night terrors, anxiety, joint pain, learning difficulties, abdominal pain, strange rashes, speech delay, severe headaches, frequent pneumonia and double vision.  Each child had different clinical manifestations with one common theme – there were no definitive answers as to why.  Could tickborne infection transmitted in-utero be contributing to their illnesses?

My infectious disease physician who was treating me at the time never mentioned that Lyme could be transmitted in pregnancy. Later after I asked, they acknowledged that yes, there were case reports.  One of my daughters also tested two-tier positive in Canada for a European strain of Lyme disease – except unlike me who had lived in Asia and travelled throughout Europe where European strains of Lyme are predominant, she hadn’t.  We both had positive tests for a European strain of Lyme disease and this was why I had asked for a meeting with my local public health unit.  I was hoping they would be interested in investigating the possibility of maternal-fetal transmission. 

Instead, the letter I received back was disheartening and disconcerting.  I was advised that despite having tested positive in Canada, using two-tier criteria, both our cases would not be counted in Canadian surveillance statistics because our symptoms were ‘non-specific’ and we didn’t have a ‘clear onset’ or ‘reliable travel history.’  Furthermore I was informed that they had completed ‘a significant amount of research and no scientific evidence to support congenital Lyme in the scientific literature was found.’ 

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Starting a Non-Profit: LymeHope  By this time, I had read more primary research papers reporting transmission of Lyme from mother to baby in-utero [iv] [v] including a report issued by the World Health Organization[vi] and Health and Welfare Canada[vii] clearly documenting the risk of this alternate mode of transmission and possible adverse pregnancy outcomes.  Shortly thereafter, myself and colleague Jennifer Kravis co-founded the Canadian not-for-profit organization LymeHope.[viii] 

In February 2017, we started a ‘Ticking Lyme Bomb’ petition[ix] which now has over 86,600 signatures and over 17,000 personal comments from across Canada.  We also arranged meetings with Federal politicians from all parties, organized a bi-partisan round-table in Ottawa on Lyme disease,[x] testified at a Parliamentary Health Committee hearing[xi] and met with senior executives, scientists and officials from the Public Health Agency of Canada and Health Canada.  We were invited to meet with then Federal Minister of Health[xii] and then leader of the Conservative Party of Canada – each time drawing attention to the many complex, serious issues faced by Lyme sufferers across Canada including the documented risk of maternal-fetal transmission.  Each meeting represented another step ‘up the mountain’ with goals of identifying and initiating meaningful, collaborative solutions including innovative research – anchored in meaningful patient engagement and triaged by patient priorities.

In 2018 I co-authored a resolution on Lyme disease which was passed by the Registered Nurses Association of Ontario (RNAO) membership titled: ‘Patient First Treatment for Ontarians with Lyme Disease.’ [xiii]  This resolution highlights the multi-faceted issues faced by Canadian Lyme sufferers and the RNAO would later feature our resolution in an article[xiv] in their Registered Nurse Journal. I am so grateful for the ongoing support of the RNAO and especially the brilliant leadership of Dr. Doris Grinspun who leads the organization.  I’ll never forget her addressing the RNAO membership at the 2018 Annual General Meeting in Toronto – this was the meeting in which our resolution was later being presented for vote.  She shared in general terms that ‘disruption’  may be necessary when confronting obstacles which stand in the way of Canadians accessing appropriate health care.   As she spoke, tears flowed down my cheeks as I recalled the numerous letters, petition comments, personal testimonies and cries for help from my fellow Canadians – adults[xv] and children[xvi] alike – struggling to access appropriate care[xvii] and treatment for Lyme disease within Canada.[xviii]  

I personally didn’t want to be labeled as a ‘disruptor’ but rather a bridge-builder and peace-maker.  I so badly wanted meaningful, sustainable change for Canadians with Lyme disease.  However, I have since learned that ‘disruption’ is sometimes necessary if it leads to re-calibration, innovation and opens new opportunities for critical thinking, trust-building, identifying strategic research initiatives and initiates forward momentum.  Many issues around Lyme disease urgently need re-investigation including adequate testing, treatment and alternate modes of transmission.  New research continues to emerge which challenges the status quo, such as the persistence of the Lyme spirochete despite antibiotic treatment.[xix]  [xx]  This is an issue which advocates, clinicians and scientists have identified for decades and is anchored in findings from hundreds of peer-reviewed papers.[xxi]  What is most important is that new research on Lyme disease must be patient relevant.  In a 2016 CMAJ editorial article by Kristen Patrick[xxii], she states, ‘For patient-relevant research to be meaningful, patient and public engagement in research cannot comprise a token lay person on a research ethics review board.  Patients and their caregivers must be involved in decision-making at all steps in the research process, from design, to choice of primary and secondary outcomes, through dissemination and implementation.’

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National Media Coverage  In 2019, CTV National News[xxiii] highlighted our advocacy work regarding maternal-fetal transmission of Lyme disease and the importance of initiating new research collaborations on this important, under-studied issue.  This national media coverage also highlighted a systematic review on gestational Lyme[xxiv] which had been authored by scientists from both the Public Health Agency of Canada and CDC.  This review included a meta-analysis which identified a significant difference in the frequency of adverse outcomes between treated and untreated pregnancies affected by Lyme disease.  

In 2020, an advocate shared with me a discovery that three Federal Canadian agencies including: Health Canada[xxv], Public Health Agency of Canada[xxvi] and Occupational Health and Safety Canada,[xxvii] had historically acknowledged the risk of adverse outcomes associated with Lyme and pregnancy and/or maternal fetal transmission of Lyme on their respective websites.  In all three cases, over a period of several years, this precautionary guidance was subsequently removed.   For years,  we had been advocating for acknowledgement of these issues which had already been publicly communicated!

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20 Years of Research Has Not Overtuned Publish Risks Adverse Outcomes  As there has been no new research in over 20 years which has negated, questioned or overturned the published findings of earlier investigators, these precautionary statements should be clearly communicated.  This is highlighted by the tenants of the Precautionary Principle and clearly communicated in a Health Canada Framework on Managing Health Risks which states: [xxviii] ‘A key feature of managing health risks is that decisions are often made in the presence of considerable scientific uncertainty. A precautionary approach to decision making emphasizes the need to take timely and appropriately preventative action, even in the absence of a full scientific demonstration of cause and effect.’ Both the public and healthcare practitioners should be made aware of these documented risks of adverse pregnancy outcomes and of in-utero transmission of Lyme itself, even if considered rare.  I have asked Canadian Public Health Agency officials for rationale as to why this guidance was removed and continue to await an evidence-based response. 

I trust that the Public Health Agency of Canada and Health Canada will follow the CDC[xxix] and NIH[xxx] in updating their public guidance on Lyme and pregnancy to acknowledge that YES, Lyme can be transmitted in utero.  With this simple, evidence-based acknowledgement as a starting point – new doors WILL open for urgent, multi-disciplinary research to better understand this alternate mode of transmission and open new avenues for families and children impacted to receive the medical care and support they need and deserve.

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So where do we go from here?  There is action, HOPE and meaningful forward momentum!  In Canada, a brand new research project on Lyme and Pregnancy was initiated in the fall of 2020 by McMaster University Midwifery Research Centre[xxxi] and remains open for participants from the US, Canada and globally, I am thankful to part of this research team.  The Canadian Association of Schools of Nursing (CASN) has just released free, open access, online resources including online learning modules for nurses and other professionals working with clients, communities and populations facing climate-driven infectious diseases.[xxxii]  This innovative resource acknowledges both the risk of maternal-fetal transmission of Lyme disease and potential for adverse pregnancy outcomes and also includes a section titled: ‘Living with Climate-Driven Vector-Borne Disease’ which highlights patient advocacy efforts, patient stories and patient centered resources.[xxxiii]  I am so proud that nurses are listening, engaging and paving an inclusive way forward which respects, empowers and includes patients.

In the US, the Cohen Foundation[xxxiv] continues to lead with generous philanthropy for Lyme disease research, innovation and collaboration.  For the last two years I have been honored to represent LymeHope as a panelist in the  LymeMind Conference[xxxv], speaking directly to the issue of maternal-fetal transmission of Lyme[xxxvi] and alongside other experts, bringing this important, understudied alternate mode of transmission back into the forefront of academia and government.  I recently spoke at a webinar hosted by Project Lyme and Mothers Against Lyme Disease [xxxvii] where I shared an overview of the literature on Lyme and Pregnancy[xxxviii]  and also shared several research recommendations for a path forward. 

The recent US HHS announcement of LymeX, in partnership with the Steven and Alexandra Cohen Foundation[xxxix] is an extraordinary step forward in bringing together diverse stakeholders including government, non-profits, academia, advocates, patients and industry to ‘accelerate Lyme innovation.’  A recent Notice of Special Interest by the NIH for improving outcomes for maternal health[xl] included ‘development and validation of diagnostics for gestational Lyme disease, which can adversely impact maternal health and pregnancy outcomes.’  All of these things are indicators of positive forward momentum and provide me with renewed Hope that new science, innovation and collaboration will lead the way and open new doors.

Four years after starting Lyme advocacy I believe that we are collectively reaching a Lyme tipping point and patients and advocates are being respected, welcomed and heard.  I admit, there have been times I have been discouraged, exhausted, frustrated and even wanted to step away from leadership.  I’m so thankful for many who encourage me to keep going.  Advocacy in a field as contentious as Lyme disease can be a lonely, misunderstood place.  Pushing for change can be met with skepticism and silence.   If we continue to take one step and another, anchored in evidence, leaning on scientific inquiry and partnered with respectful dialogue and meaningful collaboration – we will make it up to the top of the mountain. 

I really look forward to the view from the top of the mountain and one day reaching the pinnacle and planting a flag which represents the hard work and dedication of advocates, patients, scientists, researchers, not-for-profits, clinicians and government officials – all determined to make a lasting difference on behalf of Lyme sufferers . For all the families impacted by Lyme disease and those concerned that in-utero transmission may be a factor in their child’s illness – don’t give up!  I wish I could give you a big Mama-bear hug – we must keep speaking out and sharing our stories, concerns and ideas for solutions.  Our collective voice is being heard and acknowledged and I truly believe that help is on the way.


Footnotes

[i] Hercogova J, Vanousova D. Syphilis and borreliosis during pregnancy. Dermatol Ther. 2008 May-Jun;21(3):205-9. doi: 10.1111/j.1529-8019.2008.00192.x. PMID: 18564251.

[ii] Miklossy, J. (2008). Biology and Neuropathology of Dementia in Syphilis and Lyme Disease. Handbook of Clinical Neurology, 825–844. doi:10.1016/s0072-9752(07)01272-9 

[iii] Schlesinger PA, Duray PH, Burke BA, Steere AC, Stillman MT. Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi. Ann Intern Med. 1985 Jul;103(1):67-8. doi: 10.7326/0003-4819-103-1-67. PMID: 4003991.

[iv] Weber K, Bratzke HJ, Neubert U, Wilske B, Duray PH. Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy. Pediatr Infect Dis J. 1988 Apr;7(4):286-9. doi: 10.1097/00006454-198804000-00010. PMID: 3130607.

[v] MacDonald AB. Gestational Lyme borreliosis. Implications for the fetus. Rheum Dis Clin North Am. 1989 Nov;15(4):657-77. PMID: 2685924.

[vi] World Health Organization, Geneva. Weekly Epidemiological Record. No. 39. 26 September 1986. Page 297-304.

[vii] Health and Welfare Canada. Lyme Disease in Canada. Canada Dis Wkly Report, June 4, 1988.

[viii] LymeHope:  https://www.lymehope.ca/

[ix] Ticking Lyme Bomb Petition: https://www.change.org/p/minister-philpott-ticking-lyme-bomb-in-canada-fix-canada-s-lyme-action-plan-now

[x] MP Round Table and MP engagement.  https://www.lymehope.ca/advocacy-updates/update-on-mp-round-table-and-mp-engagement-regarding-lyme-disease-in-canada

[xi] Standing Committee on Health, Tuesday, June 6th, 2017.  Evidence. https://www.ourcommons.ca/DocumentViewer/en/42-1/HESA/meeting-59/evidence

[xii] Kingston, Anne.  How the Impatient Patient is Disrupting Medicine.  Macleans Magazine,  Oct, 2017. https://www.macleans.ca/society/health/how-the-new-impatient-patient-is-disrupting-medicine/

[xiii]https://myrnao.ca/sites/default/files/attached_files/Resolution%202018%20Final%20from%20AGM%20with%20amendments%20for%20website.pdf

[xiv]Registered Nurses Association of Ontario. ‘Ticking Lyme Bomb, May/June 2018. https://rnao.ca/sites/rnao-ca/files/RNJ-MayJune2018_ticking_lyme_bomb.pdf

[xv]Patient Testimonies at 2016 Federal Framework on Lyme Disease. https://www.canada.ca/en/public-health/services/diseases/lyme-disease/federal-framework-lyme-disease-conference/audio-recordings/public-forum-1.html

[xvi] Stimers, Daniel. Lyme Disease MP Roundtable Address, May 2018.  https://www.youtube.com/watch?v=Td-Vw-V7kGU&feature=youtu.be

[xvii] Gaudet EM, Gould ON, Lloyd V.  Parenting When Children Have Lyme Disease:  Fear, Frustration, Advocacy.  Healthcare 2019, 7(3), 95: https://doi.org/10.3390/healthcare7030095

[xviii] Boudreau CR, Lloyd VK, Gould ON. Motivations and Experiences of Canadians Seeking Treatment for Lyme Disease Outside of the Conventional Canadian Health-Care System. J Patient Exp. 2018;5(2):120-126. doi:10.1177/2374373517736385

[xix] Sapi E, Kasliwala RS, Ismail H, Torres JP, Oldakowski M, Markland S, Gaur G, Melillo A, Eisendle K, Liegner KB, Libien J, Goldman JE. The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease. Antibiotics (Basel). 2019 Oct 11;8(4):183. doi: 10.3390/antibiotics8040183. PMID: 31614557; PMCID: PMC6963883.

[xx] https://news.tulane.edu/pr/study-finds-evidence-persistent-lyme-infection-brain-despite-aggressive-antibiotic-therapy; https://www.frontiersin.org/articles/10.3389/fneur.2021.628045/full

[xxi]Peer-Reviewed Evidence of Persistence of Lyme Disease Spirochete Borrelia burgdorferi and Tick-Borne Diseases https://www.ilads.org/wp-content/uploads/2018/07/CLDList-ILADS.pdf

[xxii] Patrick, K. Realizing the Vision of Patient Relevant Research. CMAJ, Vol 188, Issue 15, Oct 2016. https://www.cmaj.ca/content/188/15/1063.full

[xxiii] CTV National News.  Mothers on a mission to prove Lyme disease can be passed to an unborn child. https://www.ctvnews.ca/health/mothers-on-a-mission-to-prove-lyme-disease-can-be-passed-to-unborn-child-1.4261403

[xxiv] Waddell LA, Greig J, Lindsay LR, Hinckley AF, Ogden NH (2018) A systematic review on the impact of gestational Lyme disease in humans on the fetus and newborn. PLoS ONE 13(11): e0207067. https://doi.org/10.1371/journal.pone.0207067

[xxv] Health Canada. (October 2006) https://web.archive.org/web/20061018070947/http:/www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/lyme_e.html

[xxvi] Public Health Agency of Canada (March 2009)

https://web.archive.org/web/20090307034620/http:/www.phac-aspc.gc.ca/id-mi/lyme-fs-eng.php

[xxvii]Canadian Centre for Occupational Health and Safety (May 1999)

https://web.archive.org/web/19990508215316/http:/www.ccohs.ca/oshanswers/diseases/lyme.html

[xxviii] Health Canada Decision making framework identifying, assessing and managing health risks, August 1, 2000: https://www.canada.ca/en/health-canada/corporate/about-health-canada/reports-publications/health-products-food-branch/health-canada-decision-making-framework-identifying-assessing-managing-health-risks.html#a13

[xxix] CDC. Pregnancy and Lyme Disease: https://www.cdc.gov/lyme/resources/toolkit/factsheets/Pregnancy-and-Lyme-Disease-508.pdf

[xxx] Lyme Disease, the Facts, the Challenge. NIH Publication No. 08-7045.  2008.

https://permanent.fdlp.gov/lps81243/LymeDisease.pdf

[xxxi] McMaster University Midwifery Research Centre.  ‘Health Outcomes of people with Lyme disease during pregnancy.’

English Version:  https://obsgynresearch.mcmaster.ca/surveys/index.php?s=MN9CCXDTW9

French Version: https://obsgynresearch.mcmaster.ca/surveys/?s=KWJT9K9TR9

[xxxii] Canadian Association of Schools of Nursing. Nursing and Climate Driven Vector Borne Disease.  https://vbd.casn.ca/

[xxxiii] Canadian Association of Schools of Nursing. Living with Climate Driven Vector Borne Disease. https://vbd.casn.ca/index.php/resources/living-with-climate-driven-vector-borne-disease/

[xxxiv] Cohen Lyme and Tickborne Disease Initiative:  https://www.steveandalex.org/ticks-suck/

[xxxv] LymeMIND: https://lymemind.org/

[xxxvi] 5th Annual LymeMIND Virtual Conference 2020: Mothers and Children Panel. https://www.youtube.com/watch?v=gevtoKkzS2Y&t=8s

[xxxvii] https://lymediseaseassociation.org/about-lyme/pregnancy-and-lyme/lyme-disease-pregnancy-research-opportunities-webinar/

[xxxviii] https://lymediseaseassociation.org/wp-content/uploads/2021/05/SueFaber_Maternal-Fetal-Transmission-of-Lyme-Research-Gaps-and-Next-Steps_April-29-2021_Webinar.pdf

[xxxix] LymeX initiative: https://www.hhs.gov/cto/initiatives/innovation-and-partnerships/lyme-innovation/lymex/index.html

[xl] Notice of Special Interest (NOSI): Small Business Initiatives for Innovative Diagnostic Technology for Improving Outcomes for Maternal Health

https://grants.nih.gov/grants/guide/notice-files/NOT-EB-21-001.html

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 




Lyme Disease & Pregnancy Research & Opportunities Webinar

On April 29th, 2021, Mothers Against Lyme & Project Lyme presented an interactive webinar Lyme Disease and Pregnancy: State of the Science and Opportunities for Research Support featuring Holly Ahern, MS, MT (ASCP), Sue Faber, RN, BScN, and representatives from the NIH.

It is known that Lyme disease, Borrelia burgdorferi, can cross the placenta, causing infection in unborn children, but there is little published research on the topic. This lack of information hurts healthcare providers and patients in terms of diagnosis, treatment and prevention.

The webinar, with more than 200 people registered, gave researchers an opportunity to hear the science on Lyme and pregnancy, and to learn about the application process for newly available funds from the Federal government, as presented by NIH program officers.

Watch the webinar below on YouTube. See links below for pdf’s of 2 presentations and supplemental information.

The LDA thanks Project Lyme, Mothers Against Lyme, Holly Ahearn (MS, MT), and Sue Faber RN, BScN for their work on Lyme and pregnancy and for this webinar.


The webinar was recorded and available to view on YouTube.
Click here to watch the webinar   See pdf’s below.


Below are 2 of the presentations and supplemental information in pdf form.

Lyme disease and Pregnancy – Epidemiology and Pathobiology of Borrelia: Implications for Research by Holly Ahern, MS, MT (ASCP), Associate Professor of Microbiology, State University of New York, Adirondack; Vice-President Lyme Action Network; Scientific Advisor for Focus on Lyme; Advisory Board for Mothers Against Lyme, and Mom

Maternal-Fetal Transmission of Lyme Disease: Research Gaps and Opportunities by Sue Faber RN, BScN, Co-Founder and President of LymeHope

Lyme and Pregnancy Webinar Supplemental Information by Sue Faber, RN BScN




Lyme Disease and Pregnancy: State of the Science and Opportunities for Research Support

On April 29th, 2021, Mothers Against Lyme & Project Lyme presented an interactive webinar Lyme Disease and Pregnancy: State of the Science and Opportunities for Research Support featuring Holly Ahern, MS, MT (ASCP), Sue Faber, RN, BScN, and representatives from the NIH.

Click here for LDA website article with more info on the webinar

Click below to watch webinar

 

 

 




Pregnancy, Breastfeeding & Lyme Bibliography

Any woman who has Lyme disease and is considering becoming pregnant or who is pregnant, or who is bitten by a tick during pregnancy, should see a Lyme disease doctor, one who understands the serious medical implications of Lyme during pregnancy. The Lyme bacteria, Borrelia burgdorferi, can cross the placenta and can cause death of the fetus. The Lyme Disease Association (LDA) has compiled the following list of articles related to Lyme and pregnancy and Lyme and breastfeeding for informational purposes only, for your review and review by your physician.

Project Lyme & Mothers Against Lyme Webinar – “Lyme Disease & Pregnancy: State of the Science & Opportunities for Research” featuring Holly Ahern, MS, MT (ASCP), Sue Faber, RN, BScN, & Representatives from the NIH. (2021) 

CDC Focus on Maternal-Fetal Transmission of Lyme Disease (2020)

Bale JF, Jr., Murph JR (1992). “Congenital infections and the nervous system.” Pediatr Clin North Am 39(4): 669-90.

Brzostek T. (2004). “[Human granulocytic ehrlichiosis co-incident with Lyme borreliosis in pregnant woman—a case study].” Przegl Epidemiol 58(2): 289-94.

Carlomagno G; Luksa V; Candussi G; Rizzi GM; Trevisan G Acta Eur Fertil 1988 Sep-Oct;19(5):279-81 Dept. of Obstetrics and Gynecology, University of Trieste School of Medicine. Lyme Borrelia positive serology associated with spontaneous abortion in an endemic Italian area.

Donta S, Aberer E, Ziska M. (1996). “Clinical Conference: Chronic Lyme Disease.” Journal of Spirochetal and Tick-Borne Diseases Vol.3 No.3/4 Fall Winter 1996.

Faber S. (2017). “Research findings on Lyme and Pregnancy/Congenital Transmission.” YouTube Video Retrieved from https://www.lymehope.ca/advocacy-updates/sharing-our-research-findings-on-lyme-and-pregnancycongenital-transmission-with-minister-of-health-and-public-health-agency-of-canada   The opinions presented in the video are those of the presenter and not necessarily of the Lyme Disease Association.

Gardner T. (1995). Lyme disease. Infectious diseases of the fetus and newborn infant. J. S. Remington and J. 0. Klein. Philadelphia, Saunders. Chap. 11: 447-528.

Gardner T. (2000) Lyme disease. 66 Pregnancies complicates by Lyme Borreliosis. lnfec Dis Fetus and Newborn Infant. Saunders

Goldenberg RL, Thompson C. (2003). “The infectious origins of stillbirth.” Am J Obstet Gynecol 189(3): 861-73.

Gustafson JM, Burgess EC, et al. (1993). “Intrauterine transmission of Borrelia burgdorferi in dogs.” Am J Vet Res 54(6): 882-90. (dog study)

Harvey WT, Salvato P. (2003) ‘Lyme disease’: ancient engine of an unrecognized borreliosis pandemic? Med Hypotheses. 60(5), 742-59.

Hercogova J, Vanousova D (2008). Syphilis and borreliosis during pregnancy. Dermatol Ther. 2008 May-Jun;21(3):205-9.

Jones CR, Smith H, Gibb E, Johnson L (2005) Gestational Lyme Disease: Case Studies of 102 Live Births. Lyme Times. Gestational Lyme Studies 34-36

Jovanovi R, Hajri A, Cirkovi A, et al. (1993) [Lyme disease and pregnancy]. Glas Srp Akad Nauka Med (43), 169-72.

Lakos A, Solymosi N (2010) Maternal Lyme borreliosis and pregnancy outcome. Int J Infect Dis 14(6), e494-8.

Lavoie PE; Lattner BP; Duray PH; Barbour AG; Johnson HC. Arthritis Rheum 1987; Culture positive seronegative transplacental Lyme borreliosis infant mortality. Volume 30, Number 4, 3(Suppl): S50.

Lawrence RM, Lawrence RA (2001). “Given the Benefits of Breastfeeding, What Contraindications Exist?” Pediatric Clinics of North America Volume 48, Issue 1, February 2001

MacDonald A.B. (1989). “Gestational Lyme borreliosis. Implications for the fetus.” Rheum Dis Clin North Am 15(4): 657-77.

MacDonald A.B. (1986). “Human fetal borreliosis, toxemia of pregnancy, and fetal death.” Zentralbl Bakteriol Mikrobiol Hyg [A] 263(1-2): 189-200.

MacDonald A.B., Benach J.L., et al. (1987). “Stillbirth following maternal Lyme disease.” NY State J Med 87(11): 615-6.

Maraspin, V., Cimperman J., et al. (1999). “Erythema migrans in pregnancy.” Wien Klin Wochenschr 111(22 23): 933-40.

Markowitz, L. E., Steere AC, et al. (1986). “Lyme disease during pregnancy.” JAMA 255(24): 3394-6. Because the etiologic agent of Lyme disease is a spirochete, there has been concern about the effect of maternal Lyme disease on pregnancy outcome.

Mikkelsen AL, Pa lie C. Lyme disease during pregnancy. (1987) Acta Obstet Gynecol Scand 66(5), 477-8.

Moro, Manuel H.; Bjornsson, Johannes; Marietta, Eric V.; Hofmeister, Erik K.; Germer, Jeffrey J.; Bruinsma, Elizabeth; David, Chella S.; and Persing, David H. (2001). “Gestational Attenuation of Lyme Arthritis Is Mediated by Progesterone and IL-4,” J Immunol 2001; 166:7404-7409

Mylonas I (2011) Borreliosis During Pregnancy: A Risk for the Unborn Child? Vector Borne Zoonotic Dis. 11:891-8.

Nadal D, Hunziker UA, Bucher HU, et al. (1989) Infants born to mothers with antibodies against Borrelia burgdorferi at delivery. Eur J Pediatr 148(5), 426-7. Abstract

Onk G, Acun C, Kalayci M, Cagavi F, et al. (2005) Gestational Lyme disease as a rare cause of congenital hydrocephalus. J Turkish German Gynecology Association Artemis,6(2), 156-157.

Schlesinger, P. A., Duray PH, et al. (1985). “Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi.” Ann Intern Med 103(1): 67-8.

Schutzer SE, Janniger CK, Schwartz RA (1991) Lyme disease during pregnancy. Cutis 47(4), 267-8. Abstract

Silver H. (1997) Lyme Disease During Pregnancy. Inf Dis Clinics of N. Amer. Vol 11, No 1,

Strobino BA, Abid S, Gewitz M (1999) Maternal Lyme disease and congenital heart disease: A case-control study in an endemic area. Am. J. Obstet. Gyn., 180:711-716.

Strobino BA, Williams CL, Abid S, Chalson R, Spierling P (1993)  Lyme disease and pregnancy outcome:  A prospective study of 2,000 prenatal patients. Amer J Ob Gyn, 169:367‑74.

Van Holten J, Tiems J, Jongen VH (1997) Neonatal Borrelia duttoni infection: a report of three cases. Trap Doct 27(2), 115-6.

Walsh CA, Mayer EW, Baxi LV. (2007). Lyme disease in pregnancy: case report and review of the literature. Obstet Gynecol Surv. 2007 Jan;62(1):41-50.

Williams CL, Strobino BA, Lee A, Curran A, Benach JL, Inamdar S and Cristofaro (1990) Lyme disease in childhood:  Clinical and epidemiologic features of ninety cases. Pediatr. Infect. Dis.,  9: 10‑14.

Williams CL, Strobino BA (1990)  Lyme disease and pregnancy ‑ A  review of the literature.  Contemporary Ob/Gyn, 35:48‑64.

Williams CL, Strobino BA, Weinstein A, Spierling P, Medici F (1995)  Maternal Lyme disease and congenital malformations:  A cordblood serosurvey in endemic and control areas.  Pediatric and Perinatal Epid., 9: 320‑330. 

Weber, K., Bratzke HJ, et al. (1988). “Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy.”Pediatr Infect Dis J 7(4):286-9.

Breastfeeding

Schmidt. B. L., Aberer E, et al. (1995). “Detection of Borrelia burgdorferi DNA by polymerase chain reaction in the urine and breast milk of patients with Lyme borreliosis.” Diaqn Microbiol Infect Dis 21(3): 121-8

Altaie. S. S., Mookherjee S, et al. (1996). Abstract # I17 Transmission of Borrelia burqdorferi from experimentally infected mating pairs to offspring in a murine model. FDA Science Forum.

Pregnancy & Breastfeeding

Centers for Disease Control & Prevention (CDC) website

During Pregnancy & While Breastfeeding
“Lyme disease acquired during pregnancy may lead to infection of the placenta and possible stillbirth, however, no negative effects on the fetus have been found when the mother receives appropriate antibiotic treatment. There are no reports of Lyme disease transmission from breast milk.” http://www.cdc.gov/ncidod/dvbid/LYME/ld_transmission.htm

 

 

 




Maternal-Fetal Lyme Transmission: Federal $$ & Research Support / Webinar

 
BACKGROUND
Congress recently increased annual funding for research on Lyme and related tickborne diseases at NIH by $29 million to a total of $63 million. Most of this is discretionary, although $10 million of it is mandatory for research specific to Lyme disease. In addition to this historic increase, there are opportunities for funding and research support for studies on maternal-fetal transmission of Lyme disease and the impact of pregnancy on immune response.

To stimulate researcher interest, NIH has issued a series of notices to encourage investigators to apply for grants and has asked stakeholder organizations for help getting the word out. This is an extraordinary opportunity for established investigators to build a new foundation of research for a long-overlooked problem. This is also an excellent opportunity for early-stage investigators to learn more about this field of research and receive guidance from NIH research program officers.

While it is widely accepted that Lyme disease is spread by a tick bite, it is less well known that the agent of Lyme disease, Borrelia burgdorferi, can cross the placenta, both infecting, and causing harm to, unborn children. CDC and NIH have recently acknowledged this crucial fact. Despite this, the dearth of published research on this topic has left patients, healthcare providers and caregivers to navigate a vast field of unknowns related to diagnosis, treatment and prevention, with virtually no current science to guide them.

In December 2020, a recently formed advocacy group, Mothers Against Lyme, met with officials and program officers at NIH to discuss the need for this research. The message from NIH was that plenty of funding is available, but the amount is dependent on investigator-initiated applications.


 
CURRENT OPPORTUNITIES
Following is a list of related notices of special interest and funding opportunity announcements.  In addition to tickborne diseases, these notices cover a broad range of research related to maternal-fetal medicine, obstetrics, and perinatal infectious diseases.

  • National Institute of Allergy and Infectious Diseases (NIAID)
    • NOT-EB-21-001: Small Business Initiatives for Innovative Diagnostic Technology for Improving Outcomes for Maternal Health https://grants.nih.gov/grants/guide/notice-files/NOT-EB-21-001.html
    • This multi-center notice includes a section from NIAID that calls for:
      • Development and validation of diagnostics for gestational Lyme disease, which can adversely impact maternal health and pregnancy outcome.
      • The development of technologies that detect and monitor normal dynamics of the maternal immune system during pregnancy as well as identifying clinically relevant immune dysfunction metrics for the prediction of pregnancy complications (e.g., infections, preeclampsia, sepsis) that lead to maternal morbidity and mortality.
  • National Institute of Child Health and Human Development (NICHD)
    • NOT-HD-19-021: Advancing the Understanding, Prevention, and Management of Infections Transmitted from Women to their Infants https://grants.nih.gov/grants/guide/notice-files/NOT-HD-19-021.html
      • The purpose of this funding opportunity announcement is to stimulate investigations, including translational, epidemiologic and clinical studies and trials that improve the understanding, prevention and clinical outcomes of non-HIV infections transmitted from women to their offspring during pregnancy, labor and delivery, and breastfeeding
    • PAR-20-298: Development of the Fetal Immune System https://grants.nih.gov/grants/guide/pa-files/PAR-20-298.html
      • The purpose of this funding opportunity announcement is to understand the contribution of specific elements of maternal molecular and cellular factors that can control and effect the development of the fetal immune system.
  • Department of Defense (DOD)
    • Funding for research on maternal-fetal transmission of Lyme disease is available through the DOD Congressionally Directed Medical Research Program for Tickborne Diseases, which is currently funded at $7 million annually.
    • DOD Tick-Borne Disease Research Program Funding Opportunities for FY 2021https://cdmrp.army.mil/pubs/press/2021/21tbdrppreann
      • This notice includes a call for research on understanding the potential role of maternal-fetal transmission and the ability to prevent TBDs by this mode of transmission.

 
WEBINAR FOR RESEARCHERS
If you are interested in learning more, please consider attending the webinar: Lyme Disease and Pregnancy: State of the Science and Opportunities for Research Support

Thursday, April 29 from 5:00 – 6:30 pm EST. There is no charge to attend. This webinar is hosted by Mothers Against Lyme & Project Lyme. You will learn about the urgent need for this research, the state of the science and research gaps, and opportunities for funding and research support. You will also be able to interact directly with research program officers from NIAID and NICHD.

NOTE: Thanks to Bruce Fries – President, Patient Centered Care Advocacy Group & Advisor for Research and Public Policy for Mothers Against Lyme – for this information, and thanks to both groups for their work on this issue. Patient Centered Care Advocacy Group is an LDAnet partner organization.




Lyme & Pregnancy Research Study

Click here for detailed information on the Lyme & pregnancy research questionnaire/survey and to participateThe issue of Lyme disease and pregnancy is a serious one, and much more research and education is needed to understand the extent and scope of the problems related to pregnancy and Lyme. The Lyme Disease Association (LDA) is providing information on a study on Lyme and Pregnancy which is led by researchers from the McMasters Midwifery Research Centre in Canada.

The LDA does not recommend or endorse the study but provides the information as a service to those who may want to participate.

Click here for detailed information on the research questionnaire/survey and to participate

Click here for LymeHope update




CDC Focus on Maternal-Fetal Transmission of Lyme Disease

The Centers for Disease Control (CDC) updated its website to include information regarding  maternal-fetal transmission of Lyme disease.

Updates from the CDC website:

  • Lyme disease Transmission page under “Are there other ways to get Lyme disease?”: “Untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare. Fortunately, with appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes. There are no published studies assessing developmental outcomes of children whose mothers acquired Lyme disease during pregnancy.”
  • Lyme Disease FAQ page under “I am pregnant and think I have Lyme disease, what should I do?”: “If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately. Untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare. Fortunately, with appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes.* There are no published studies assessing developmental outcomes of children whose mothers acquired Lyme disease during pregnancy.”
  • Pregnancy and Lyme disease poster: information on symptoms, diagnosis, and treatment. Regarding breastfeeding the poster states, “There are no reports of Lyme disease transmission through breast milk.”

LDA President, Pat Smith, said this about the CDC’s recent update, “The maternal-fetal aspect of Lyme disease, mother to baby transmission, has long been known but not well-publicized. The new CDC focus on this Lyme transmission method has been missing in Lyme disease education. A number of advocacy groups, including the LDA, have had information on their websites. LymeHope in Canada has been strongly advocating for wider recognition of this aspect, in particular nurse Sue Faber, who spoke before the HHS TBD Working Group in DC in January 2020. Now it is up to all of us to call attention to this CDC focus to ensure health departments and physicians are aware of the situation and that they take appropriate steps to ensure pregnant women get the necessary care.”

Visit the CDC Lyme disease website.

View the LDA’s Pregnancy, Breastfeeding & Lyme Bibliography.