Good Luck to you

Take Care
Abbie

------------------
You can only see the stars when its the darkest.................

Here is some information previously posted by pacbird, I hope it helps.

Good luck to you both.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Posted by pacbird.
"Here's a bunch of stuff I had in my files.
It's pretty long (sorry)I have more if you are interested.
Ask Dr. J to share his gestational study next time you go.
source: Coping With Lyme Disease by Denise Lang
pg. 135
"If you are pregnant and have been bitten by a tick in an endemic area, are displaying symptoms consistent with Lyme disease, or have been diagnosed with Lyme in the past:
".....
"4. After the birth be vigilant in your observations regarding the health of your baby. Even though a baby born to a Lyme mother may appear to be healthy at the moment of birth, it is still possible that transplacental Lyme symptoms can crop up months later. There is no need to be paranoid and neurotic about this; just be observant and consider the possibility if chronic illness becomes a way of life for your infant.
"5. Breast feeding is also not recommended if you have had Lyme disease during the previous year, since Lyme spirochetes have been isolated from breast milk.
" A pregnant woman worries about a lot of things that will affect her baby's health---and rightly so. It is important that doctors realize that, far from being hysterical, most women today are somewhat knowledgeable about their bodies and various health and enviornmental threats. Complaints of diffuse and migratory symptoms during pregnancy should be treated with respect, not simply dissmissed as 'pregnant women's blues,' curable through Lamaze breathing. Pregnant women must expect and demand this respect and treatment---and seek additional help when they don't receive them."

from: Everything You Need To Know About Lyme Disease by Karen
Vanderhoof-Forschner

pg. 14 Are Tick Bites The Only Source of Lyme Disease?
"There has been only a very limited amount of research into the ways by which the Bb spirochete may be transmitted other than through a tick bite. Indeed, this is such a controversial area that most researchers are reluctant even to probe into it. My belief, however, is that what we don't know can hurt us, and it makes sense to explore all possible avenues, especially those described here."
Pregnancy and Breastfeeding
"The possibility that tick-borne diseases can be transmitted to the developing fetus during pregnancy is one of the most wrenching issues we deal with at the Lyme Disease Foundation. My own personal tragedy, and the loss of my infant son, galvanized me into action, and my concern for other pregnant women continues to spur me on. Because 20% of women in the United States and Europe are of childbearing age, the risks of Lyme disease demand our attention "Although data on this subject remain scarce, research demonstrates that a pregnant woman who becomes infected with Bb and does not receive prompt antibiotic treatment can transmit the bacteria through the bloodstream to her fetus, with potentialy dire consequences. Rest assured, however: Pregnant women who do receive appropriate treatment generally do very nicely. "In 1985, The Annnals of Internal Medicine became the first medical journal to publish an article describing a case of maternal/fetal transmission that resulted in the death of an infant. In another study, discussed by T. Gardner in a chapter of Infectious diseases of the Fetus and Newborn, 161 cases of Lyme disease during pregnancy were reviewed, and some sort of adverse outcomes were found in 46 of them. The risk to fetal development was highest if a woman became infected during her first trimester of pregnancy. The author concludes outcomes (which may be relatively mild or very severe) occur 63% of the time in the first trimester, 38% of the time in the second trimester, and just 10% of the time if infection occurs in the final trimester.
"Documented adverse outcomes include a risk of retarded growth, respiratory distress, eye problems, brain infection, heart abnormalities, and damage to other organs. On rare occassions, fetal malformations, miscarriage, and ealy infant death have been linked to Lyme disease, and the spirochete has been recovered from both fetal remains and placental tissue. In addition, the possibility that Lyme disease in pregnancy is linked to susequent developmental delays and learning disabilites has been documented.
"Also of concern are the results of recent studies suggesting that it may be possible to transmit infection in breast milk. A study published by B. Schmidt in 1995 detected Bb in two samples of milk provided by lactating women with Lyme disease. A year later, a study conducted with mice also proved that early
breast milk from an infected mother could transmit the infection to the newborn. This experiment raises questions about earlier assumptions that an infants's stomach acid would most likely kill any Lyme bacteria. "While every pregnant and nursing woman needs to take special precautions to prevent tick bite, there is no surefire way to stay safe. Securing an accurate diagnosis can be challenging, especially given the many discomforts that are a part of almost any pregnancy. If you are pregnant and are bitten by a tick, prompt antibiotic treatment is crucial, even if you don't know for sure that you have been infected."

Reader's Digest 1989 Apr: The mounting toll of Lyme disease.
The mounting toll of Lyme disease.

Pekkanen J

Lyme disease has surpassed Rocky Mountain spotted fever as the most prevalent tick-borne disease in this country. Unknown 15 years ago, the disease is reaching epidemic proportions. About half of the people infected with the responsible bacteria develop a rash, light red to nearly purple, which often expands with a white center and red border. If a person is treated when the rash first appears, the risk of later complications is greatly reduced. A flu- like illness with profound fatigue can occur before, during, or after the appearance of the rash. Days or even months after the original tick bite, arthritis-like manifestations develop in the knees or other large joints. These symptoms wax and wane and eventually disappear in most people, but in a few patients the symptoms may recur for years and permanently damage joints. On occasion, Lyme disease can involve the heart, liver, spleen, eyes, kidneys, and lungs. Perhaps the greatest worry, though, is damage to the brain. In a survey of 600 patients with advanced Lyme disease, 23% developed neurological complications. For most, the symptoms are relatively mild and controllable with antibiotics. But those who go too long without treatment, or who don't respond to antibiotics, can suffer recurrent limb numbness, facial palsy, seizures, and excruciating headaches. Sometimes the signs of Lyme disease may mimic those of other neurological illnesses, such as multiple sclerosis, Alzheimer's disease, and amyotrophic lateral sclerosis (Lou Gehrig's disease). Some experts fear that some people with relatively mild cases may experience serious neurological problems long after the initial infection. Fortunately, newer antibiotics, especially the third-generation cephalosporins, can cross the blood-brain barrier and usually reverse neurological problems. A final concern is Lyme disease in pregnancy, which has produced severe birth defects. Fortunately, the risks to the fetus are minimized if the disease is adequately treated in pregnancy.

Two articles to read are--
Gestational Lyme Borreliosis Implications for the Fetus
author: Alan MacDonald
source Rheumatic Disease Clinics of North America Volume 15/Number 4 November 1989 pages 657-677
publisher: W.B. Saunders

Lyme Disease by Tessa Gardner, M.D.
Chapter 11
source: Infectious Diseases of the Fetus and Newborn Infant---4th edition, pgs. 447-528
publisher: Saunders
Lyme is caused by a spirochete and has been shown to cause many of the same symptoms another spirochetal disease, syphilis, causes (from: Disarming Lyme Disease by Fred Kantor, one of the patent holders of Smith Klein and Beecham's Lyme disease vaccine. "...Interestingly all this research into Lyme disease may help improve understanding of syphilis, which displays many similarities to Lyme disease. The microbe that causes this sexually transmitted disease is another spirochete ---Treponema pallidum. It, too, is capable of disseminating to many different kinds of tissues and causing chronic, antibiotic -resistant disease in some people. Further, many of the symptoms of syphilis resemble those of Lyme disease. Like B. burgdorferi, T. pallidum can cause skin rashes, cardiac abnormalities, nerve pain, and dementia....." This article appeared in The Scientific American. )
One way to learn about Lyme disease is to read about the other spirochetal diseases.
Here is an excerpt from the 1st article I listed--Gestational Lyme Borreliosis Implications for the Fetus by Alan MacDonald,M.D.
pg. 662
"The clinical diversity of Lyme borreliosis is a formidable diagnostic challenge to the physician which is matched by the labyrinthine complexity of congenital syphilis. Three quintessential paradigms from the literature on congenital syphilis appeared in the textbook by Stokes in 1945: (8) Dr. MacDonald quotes Stokes:
1." 'Prenatal syphilis is a collection of rare events of interest to the connoisseur of the elegant art of medical investigative diagnosis.' 2. 'The diagnosis of syphilis in a dead fetus is just as difficult as the diagnosis of syphilis in a living fetus.'
3. " Never 'always', Never 'never.'......... .....".................... " ' Table 3 Vignettes from Clinical Observation of Prenatal Syphilis

'Seronegative results are absolutely untrustworthy.'
'The exact date of maternal or fetal infection is often impossible to determine.'
'Asymptomatic, seronegative mothers may bear syphilitic children.' 'Prenatal syphilis may only appear as a tardive manifestation in the child after birth.'
'REPEATED UNSUCCESSFUL PREGNANCY (MISCARRIAGE OR STILLBIRTH) HAS A HIGH VALUE AS A DIAGNOSTIC CLUE TO MATERANAL SYPHILIS.' "
back to Macdonald--
"3. The diversity of prenatal syphilis at the clinical level is illustrated below and the laboratory diversity of prenatal syphilis is presented in Table 4 (note that approximately 20% of infants who acquired syphilis in utero were seronegative at birth).
"The manifestations of heredosyphilis in newborn babies include eruptive cutaneous lesions; snuffles; irritability; fissured lips; pseudoparalysis of Parrot" (pseudoparalysis caused by syphilitic osteochondritis.) "; anemia; mucous patches; anal condyloma lata; aphonic cry; marasmus "(emaciation and wasting in an infant due to malnutrition..) "; nephritis; icterus "(jaundice)" neonatorum;
and no clinical symptoms detectable at delivery.
"Tardive manifestations of prenatal syphilis that are not apparent at birth, but develop in childhood or adolescence include: Hutchinson incisor; scaphoid scapula; interstitial keratitis; eigth nerve deafness; saddle nose; hydroarthritis of Clutton; optic atrophy; and hydrocephalus....." another reference--
from: Clinical Manifestations of Lyme Disease in the United States authors: Trock, et al
Source: Connecticut Medicine June 1989 Volume 53, No. 6
"...........In a prospective study of
abortuses in an area endemic for Lyme disease, four cases of fetal borreliosis were described with B. burgdorferi isolated from fetal liver. This observation suggests that B. burgdorferi may be an etiologic agent in fetal demise of uncertain cause. The risk to infants of asymptomatic women with positive serologies for Lyme disease has been explored through analysis of cord blood for anti-B. burgdorferi antibodies....The development of these infants warrants further observation, especially since in another spirochetal infection, congenital syphilis, abnormalities are not always evident at
birth................."

from the dejanews archives:

The following is an e-mail from BELLADADDY- she asked me to post the info to the newsgroup
__________________________________________________________
--you all must go to your local hospital's library and xerox copy the chapter in this text book!!!
80 pages on Lyme with a focus on CLD...by Tessa Gardner- She is a pediatric infectious disease specialist in the midwest....she lists 400+ references... INFECTIOUS DISEASES OF THE FETUS AND NEWBORN INFANT--CHAPTER 11
___________________________________________________________________
Source # 1:
Text: Lyme Disease (tiny green hardcover book @ local hospital library)
by Patricia Coyle of State University of NY @ Stonybrook

Chapter 23 Lyme Disease in Pregnancy
Genevieve Sicuranza and David Allen Baker
Lyme borreliosis became a reportable disease in the United States in 1982, and in 1991 a national surveillance case definition was established. The Centers for Disease Control in its June 1991 report indicated an eighteenfold increase in the number of cases from 1982 through 1989(13,500). Lyme disease was first described in 1977 in Old Lyme, Connecticut, as a juvenile-arthritis type syndrome associated with tick bites.'(ref 12) Although cases are concentrated in the northeastern, midwestern, and Pacific United States, Lyme disease has now been reported from most states. It is clearly an international problem, with a marked increase in infected and symptomatic people in Europe and Asia as well. Due to the rising numbers of cases each year, there has been increasing concern about the potential impact of Lyme disease on the pregnant woman and her fetus.
Lyme disease is caused by a spirochete, Borrelia burgdorferi, classically carried by the deer tick, hodes dammini.(ref10) Other vectors have been identified in New Jersey and Texas (Amblyomma americanum). (ref 11) Although the deer is the preferred host of the adult tick, almost any bird or domestic animal can act as an intermediate host. It is known that the fetus is quite vulnerable to the transplacental passage of the syphilis spirochete, Treponema pallidum. Because the causative agent of Lyme disease is also a spirochete, there is concern that B. burgdorferi might also affect the fetus. This chapter reviews the available information pertaining to Lyme disease in pregnancy and discusses the diagnosis and management in this selected population. (See Color Plate 8.)

PREGNANCY
Maternal infection may involve transmission of the invading microorganism to the fetus. This may have no adverse consequences or may produce a range of sequela from minor transient problems to fetal death and abortion. Among the spirochetal bacterial infections, syphilis is known to cause abortion, stillbirth, and congenital abnormalities. Maternal relapsing fever and leptospirosis have also been associated with an increased risk of fetal loss.

Among animals, borreliae have been associated with bovine abortion. Whether Lyme disease affects the pregnancy or the fetus has been a subject of several studies. In 1985, Schlessinger (ref 8) documented transplacental transmission of B. burgdorferi for the first time. The infant involved showed congenital heart anomalies. An autopsy revealed numerous spirochetes in the spleen, kidney and bone marrow. The chorionic villi had histologic evidence of involvement with increased numbers of Hofbauer cells. The mother in question had been infected during the first trimester and had not received treatment. The Centers for Disease Control conducted a retrospective study on 19 women with Lyme disease. (ref 5) There were five poor outcomes:
prematurity. cortical blindness, fetal demise, syndactyly, and rash. No association was noted between a poor outcome and the trimester in which infection occurred, or whether treatment was given. A second study conducted by the Centers for Disease Control (ref 5) involved a prospective analysis of 17 females infected during the first trimester. In this small prospective study, one infant was born with syndactyly and there was one spontaneous loss at 13 weeks. All the other pregnancies resulted in normal infants.
From 1986 through 1987, Nadal et a (ref 17) surveyed over 1000 mothers at deliveries where anti-B burgdorferi antibody titers were obtained. ** see note below
Of these 1000 mothers, 12 had elevated titers, but only one mother was symptomatic with Lyme disease during her first trimester. Her child was born with a ventricular-septal cardiac defect (VSD). None of the children born to mothers with a positive titer had detectable antibodies. Of the 12 mothers with positive titers, 8 delivered at term, 2 were preterm and 2 were postterm. Seven infants had problems in the newborn period: there were two cases of hyperbilirubinemia and one case each of hypotonia; (attributed to medication), microcephaly, supra-ventricular extrasystoles, VSD, and small for gestational age when examined between 9 and I7 months of age; however, only the child with the VSD remained abnormal.

MacDonald published two papers regarding
Lyme disease in pregnancy. He described four cases of fetal borreliosis found while prospectively studying abortuses.(ref 4) His findings included one term stillbirth and three second-trimester losses. One of the second-trimester losses was complicated by toxemia and another by systemic lupus erythematous. B. burgdorferi was cultured from the fetal liver in each case. From the term stillbirth, spirochetes were found in the liver, heart, adrenal, brain, kidney, meninges, and subarachnoid. Three of the cases had identifiable cardiac malformations:
atrial-septal defect, VSD, and coarctation of the aorta. He questioned whether or not B. burgdorferi could be a cause of fetal demise, congenital heart defect, or fetal loss after toxemia. In l989, MacDonald described several other cases. One was a 25-year-old black woman at term in labor who delivered a male fetus who was small for gestational age with multiple anomalies including VSD in addition to central nervous system (CNS) anomalies. B. burgdorferi was identified in the fetal autopsy. Another was a term intrauterine growth-retarded infant who succumbed to a large VSD and absence of the left hemidiaphragm. This autopsy also found spirochetes in tissue. MacDonald also reports several second-trimester losses, with and without anomalies, that at autopsy revealed B. burgdorfen. In the same article, MacDonald refers to a retrospective study of 10 sudden infant deaths; he reported that 2 had spirochetes consistent with B. burgdorferi in the brain. No other laboratory, however, has confirmed this high report of spirochetal invasion of the fetal and placental tissue.
In contrast to these reports of MacDonald, (ref 3,4) the Fourth International Conference on Lyme Borreliosis held in Stockholm in June of 1990 concluded that there is little risk to the fetus.(ref 9) The symposium examined a large retrospective study in which there was no increased rate of congenital malformations in infants with seropositive mothers. The symposium referred to a study in which there were six pregnant women with Lyme disease, all of whom had healthy infants. Another study, which surveyed pediatric neurologists in areas highly endemic for Lyme disease, failed to discover any (??!!) records of neurologic cases that could be attributed to Lyme disease.
In a series of 143 pregnant women from Wisconsin, titers for B. burgdorferi exposure were examined and correlated with pregnancy outcome. In the group, the incidence of first-trimester spontaneous abortions was no greater for seropositive women than for seronegative women.

DIAGNOSIS
According to the Centers for Disease Control (ref 5) a diagnosis of Lyme disease in pregnancy can be made with certainty if erythema migrans (EM) is present or if there is the new onset of typical neurologic, cardiac, or joint involvement in a pregnant woman accompanied by laboratory confirmation of infection (typically diagnostic antibody levels or a significant rise in acute versus convalescent antibody levels; isolation of spirochetes from a clinical sample is also acceptable). In reality, however, patients in whom there is a reasonable clinical suspicion for Lyme disease warrant treatment.

TREATMENT
According to the Centers for Disease Control, any pregnant woman with the diagnosis of Lyme disease, or the suspicion of it, should be treated.(ref 5) The diagnosis should be a clinical one and not based on serology because serologic conversion may occur too late in the disease process. The problems with current antibody assays, and the problem of seronegativity, are addressed in Chapters 14 and 25. In the Centers for Disease Control study, 3 of 13 patients treated had abnormal fetal outcomes (23%), as did 2 of the 6 patients who were not treated (33%). According to their study, the time of the disease in relation to poor outcome and whether the patient was treated were not significant. The Centers for Disease Control admitted that none of these adverse outcomes was documented to be a direct sequela of Lyme disease. These adverse outcomes are only possible associations of Borrelia burgdorferi maternal infection (Table 23-1).

Table 23-1 Adverse pregnancy outcomes with possible association to Lyme disease Congenital anomlies (especially heart, great vessels)
Congenital cortical blindness
Miscarriage
Small for gestational age
Stillbirth
Toxemia

According to Mikkelsen and Palle, (ref 6) to avoid a potential adverse effect on the fetus, the mother should be treated aggressively. Treatment is guided by the clinical manifestations of the disease (Table 23-2).

Table 23-2
Treatment of Lyme disease during pregnancy
Disease stage Antibiotic regimen
Uncomplicated erythema migrans after first trimester:
Amoxicillin 500 mg P0 tid-qid x 21-30 days
Erythromycin 250 mg P0 qid x 21-30 days
[Newer macrolides such as Azithromycin may prove to he superior to erythromycin]
Avoid tetracyclines, probenecid

Disseminated or late disease; first trimester infection Intravenous antibiotics for 2-4 weeks
Ceftriaxone 2g
Penicillin G 20 million U qd

Lyme disease limited to the skin can probably be treated with amoxicillin or erythromycin (see Chapter 18 for a different approach). Probenecid should not be used, and the tetracyclines should be avoided. Disseminated disease, and infections in the first trimester, should be treated with parenteral antibiotics (ceftriaxone or penicillin - ref 6).

In 1987, Mikkelsen and Palle (ref 6) reported the case of a 29-year-old woman who during her 24th week was bitten by a tick. She developed EM without any systemic manifestations, with a positive antibody titer. She was treated with penicillin for 10
days and subsequntly delivered a term baby. Histologic study of the placenta was negative, and the antibody titer in cord and maternal blood was not elevated.

SUMMARY
A body of evidence (ref 3 and 4) suggests that the causative agent of Lyme disease, B. burgdorfen, can cross the placenta and infect the fetus. There are also several reports that suggest that this may be associated with a poor fetal outcome. However, the majority of studies have not been able to identify B. burgdorferi as a direct cause of spontaneous abortions, congenital anomalies, or neurologic sequelae in infants.
It is essential to realize that in the pregnant woman Lyme disease is a clinical diagnosis regardless of her serologic status. Because the precise risk to the fetus from an infected pregnant female is not yet clear, it is important to be aggressive in the diagnosis and management of Lyme disease. This is important not only for the fetus, but also for the mother. The mother is certainly at risk for serious and potentially debilitating manifestations of Lyme disease including arthritis, carditis, and neurologic problems. In conclusion, Lyme disease in pregnancy is a clinical diagnosis irrespective of serologic status.

The diagnosis must be made promptly, and treatment must be instituted in the interest of maternal, in addition to fetal, welfare.

REFERENCES
1. Centers for Disease Control, MMWR 40(25):417, 1991.
2. Dlesk A et al: Lyme seropositivity and pregnancy outcome in the absence of symptoms of Lyme disease, Arthritis Rheum 32(suppl):S46, 1989. 3. MacDonald AB: Human fetal borreliosis, toxemia of pregnancy, and fetal death, Zentralbi Bakieriol Mikrobiol Hyg
[A] 263:189, 1986.
4. MacDonald AB: Gestational Lyme borreliosis, Rheum Dis Clin North Am 15(4):657, 1989.
5. Markowitt LE et al: Lyme disease during pregnancy. JAMA
255(24):3394, 1986.
6. Mikketsen AL, Palle C: Lyme disease during pregnancy. Acta Obstet Gynecol Scand 66:477, 1987.
7. Nadal D et al: Infants born to mothers with antibodies against Borellia burgdorferi at delivery, Eur J Pedjair
148:426, 1989.
8. Schlessinger PA et al: Maternal-fetal transmission of Lyme disease spirochete Borrelia burgdoDferi, Ann Intern Med
103:67, 1985.
9. Sigal LH: Summary of the Fourth International Symposium on Lyme Borreliosis, Arthritis Rheum 34(3):367, 1991.
10. Steere AG: Lyme disease, N Engi J Med 321:586, 1989.
11. Steere AC, Malawista SE: Cases of Lyme disease in the United States: locations correlated with distribution of Ixodes dammini, Ann Intern Med 91:730, 1979.
12. Steere AC et al: The clinical spectrum and treatment of Lyme disease, Yale J Biol Med 57:453, 1984.

***Infants infected in the first trimester, do not make antibodies (soldiers to the bacterial antigen) because their young immune system does not recognize the infection as foreign......See Altaie, Sousan..."