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Lyme Disease in Pregnancy: Case Report and Review of the Literature

Walsh, Colin A. MB*; Mayer, Elizabeth W. MD†; Baxi, Laxmi V. MD‡

Obstetrical & Gynecological Survey: January 2007 - Volume 62 - Issue 1 - pp 41-50
doi: 10.1097/01.ogx.0000251024.43400.9a
CME Program: CATEGORY 1 CME REVIEW ARTICLES 1, 2, AND 3: CME REVIEW ARTICLE 1

Lyme disease is the most common vector-borne disease in the United States. A number of other spirochetal diseases, if contracted in pregnancy, have been shown to cause fetal harm and there is concern over a similar effect with gestational borreliosis. Previously published individual case reports have suggested a possible association between gestational borreliosis and adverse pregnancy outcome; however, no specific pattern of teratogenicity has been shown, and a causal relationship has never been proven. In addition, larger epidemiological and serological series have consistently failed to demonstrate an increased risk to pregnant women who develop Lyme disease if they receive appropriate antimicrobial therapy. We describe a favorable outcome in a 42-year-old woman who developed Lyme disease in the third trimester and was treated with a full course of oral amoxicillin. In addition, we offer a review of the relevant literature regarding Lyme disease and pregnancy. The appropriate investigation and management of a woman with gestational borreliosis are discussed.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to recall that Lyme disease is not an uncommon disease during pregnancy and can occur in states outside of the Northeast, explain that the diagnosis is made clinically and may be confirmed by laboratory tests, state that treatment is recommended during pregnancy, and summarize that there is no consistent data of adverse fetal effects even though the placenta is infected.

*Resident and ‡Professor, Department of Obstetrics and Gynecology, Columbia University Medical Center at the New York Presbyterian Hospital, New York, New York; and †Assistant Clinical Professor, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2007. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprints will not be available.

Address correspondence to: Dr. Laxmi Baxi, Professor of Clinical Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032. E-mail: lvb1@columbia.edu.

© 2007 Lippincott Williams & Wilkins, Inc.