Lähettäjä: Lyme2006 Lähetetty: 18.5.2006 14:47
Tietääkö kukaan tai onko Suomessa/maailmalla tehty tutkimuksia borrelioosin siirtymisestä raskauden aikana tai synnytyksessä vauvaan. Sairastuin borrelioosiin 3 1/2 vuotta sitten, mutta valitettavasti sain diagnoosin ja hoidon vasta reilu kuukausi sitten. Olen huolissani, vaikka sairaalalääkärin mukaan lapseni (nyt 2v 7 kk) ei ole voinut saada tartuntaa minusta. Olen hieman epäuskoinen asian suhteen? Osaatteko auttaa? Kiitos avusta jo etukäteen.
BORRELIOOSI JA RASKAUS
Valvojat: Jatta1001, Borrelioosiyhdistys, Bb
Lähettäjä: Soijuv Lähetetty: 18.5.2006 19:51
Hei, olen kirjoittamassa aiheesta artikkelia kotisivuillemme (todennäköisesti vasta syksyllä). Asiaa on tutkittu jonkin verran maailmalla ja sen lisäksi vanhemmat kertovat asiasta esim. eri maiden keskustelupalstoilla. Tapasin aikoinaan Amerikassa muutamia vanhempia, joiden lapset sairastivat borrelioosia joko syntymästä saakka tai nuoresta pitäen. Yhdessä perheessä 4 lasta sairasti borrelioosia. Lapsien oireet olivat alkaneet eri ikäisinä. Äiti oli vakuuttunut että lapset olivat saaneet taudin häneltä jo raskauden aikana. Myös muutamalla yhdistyksemme jäsenellä on asiasta henkilökohtaisia kokemuksia.
Tutkimuksissa borreliabakteereita on löydetty äidinmaidosta, emättimestä, miehen siemennnesteestä jne. ja bakteeri kykenee siirtymään istukasta sikiöön. Eläimillä on todettu borrelioosista johtuvia sikiökuolemia ym. Joitakin tapauksia on tavattu myös ihmisillä.
Tutkimuksissa näkyy pääasiassa borreliabakteerin välittömät seuraukset kuten keskenmenot ja synnynnäiset epämuodostumat jne. Sitä ovatko lapsen myöhemmässä elämässä ilmenevät terveysongelmat mahdollisen borreliainfektion aiheuttamia, ei ole tietääkseni tutkittu. Asiaa olisikin vaikea tutkia sillä oireet voivat johtua esim. myöhemmällä iällä saadusta infektiosta. Olemassaolevien tutkimusten pohjalta vaikuttaisi kuitenkin siltä, ettei lapsella ole kovin suurta riskiä sairastua, vaikka äiti sairastaisikin borrelioosia raskauden aikana.
Ps. Mikäli haluat asiasta lisää tutkimuksia, voit kirjoittaa/soittaa minulle. Yhteystietoni ovat kotisivuilla.
Seuraavassa muutamia tutkimuksia:
1. Teratogen Update: Lyme Disease
Teratology 64:276?281,2001.
DANIEL J. ELLIOTT,1 STEPHEN C. EPPES,2 AND JOEL D. KLEIN2*
1 Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
2 Department of Pediatrics, Division of Infectious Disease, A I duPont Hospital for Children,
Wilmington, Delaware 19899
ABSTRACT We reviewed the world literature concerning the reproductive effects of Lyme disease (LD). Borrelia burgdorferi, which is the etiology of LD, is a spirochete and, as such, may share the potential for causing fetal infection, which may occur in the setting of maternal spirochetemia. Information concerning the effects of gestational LD derives from case reports and series, epidemiologic studies, and experimental animal models. Although provocative, these studies fail to define a characteristic teratogenic effect. However, skin and cardiac involvement have predominated in some reports. Pregnancy wastage has been suggested primarily by animal studies. Gestational LD appears to be associated with a low risk of adverse pregnancy outcome, particularly with appropriated antibiotic therapy. Suggestions for management of clinical situations are presented. Teratology 64:276?281, 2001. © 2001 Wiley-Liss, Inc.
DISCUSSION
Attempts to define the clinical significance of gestational Lyme disease have been limited seriously by several factors.
First, the prevalence of Lyme disease in pregnant women, even in highly endemic regions, is low, making it difficult to perform statistically significant case-control and other epidemiological based studies.
Second, it is difficult to define B. burgdorferi infection, especially in the absence of clinical markers such as EM.
Studies relying on LD seropositivity, a history of a tick bite, or even retrospective clinical history are unreliable in diagnosing LD in pregnant women and may make studies of gestational LD questionable.
Third, owing to increased awareness and concern about Lyme disease, particularly in pregnant patients, most will have received
antibiotic treatment.
For these reasons, our understanding of the outcome of untreated gestational Lyme disease is based on a small number of case reports and pathological studies that in some instances occurred without the benefit of accurate diagnostic techniques.
Despite these limitations, it is possible to address several aspects of gestational Lyme disease.
First, does B. burgdorferi cross the placenta and invade the fetus?
Second, if there is transplacental transmission, does this have any significance for the development of the fetus? Finally, is there an overall effect on pregnancy without regard to direct fetal infection?
Studies in both human and animal models have established that B. burgdorferi can cross the placenta, presumably occurring during a period of spirochetemia.
The clinical significance of transplacental transmission in humans remains unclear, however given the absence of a documented fetal inflammatory or immunologic response, which would be expected if the spirochetes were causing active infection. Perhaps the most compelling argument against the teratogenicity of gestational Lyme disease is the lack of a consistent clinical outcome in affected pregnancies.
Initially the most concerning potential associations involved congenital cardiac malformations and fetal loss.
Subsequent epidemiologic research has cast significant doubt on this association. The relationship between gestational Lyme disease and fetal loss also remains unclear. Because gestational Lyme disease has been clearly linked to fetal loss in animal studies, the potential for a causal effect in human gestational LD exists.
A connection between fetal and maternal infection in humans with other spirochetes, such as Borrelia recurrentis and Leptospira canicola has been demonstrated (Gaud et al., ?47; Coghlan, ?69).
Despite documentation of transplacental transmission of Borrelia burgdorferi, there has been no evidence for a fetal inflammatory or immune response or a consistent clinical outcome resulting from gestational Lyme disease. An analysis of current evidence, therefore, indicates that an adverse fetal outcome due to maternal infection with B. burgdorferi at any point during pregnancy in humans is at most extremely rare.
--------------------
2. Strobino B, et al. Maternal Lyme disease and congenital heart disease: a case-control study in an endemic area. Am J Obstet Gynecol. 1999;180:711-716.
A follow-up to the study above which used patients form the same endemic geographical area. Cases and controls were 7 year old (or less) patients of a large pediatric cardiology service. There was a 39% maternal response rate of a questionnaire that obtained perinatal information.
Maternal characteristics and exposures were comparable. Criteria for Lyme disease was either characteristic symptoms or diagnosis by a physician.
For purposes of analysis, Lyme disease before or during pregnancy was considered a single exposure category. There was no association between Lyme disease before or during pregnancy and congenital heart disease.
-------------------------
3. Silver HM. Lyme disease during pregnancy. Infectious Disease Clinics of North America. 1997;1:93-97.
A literature review which included the citations referenced above (excepting the 1999 study).
Reference was made to a 1986 CDC study which reviewed outcomes of 19 pregnancies complicated by Lyme disease. Five had abnormal outcomes which included fetal death, cortical blindness, vesicular rash, preterm delivery, and syndactyly.
A Swiss study reported VSD in the infant of a mother with untreated Lyme disease. "As the (Lyme) disease is uncommon, and anomalies less common, larger epidemiologic studies are required for a definitive resolution to the question of fetal risks with perinatal infection."
Conclusions: There have been isolated case reports of a variety of congenital malformations following maternal Lyme disease during pregnancy. Epidemiologic evidence thus far has not completely answered the question whether or not these associations are related to Lyme disease or to chance occurrence. Part of the problem is that it is difficult to retrospectively diagnose Lyme disease. This is because it is possible to have characteristic symptoms without an antibody response and vice versa. Another problem is that some investigators combine Lyme disease before or during pregnancy as an exposure category. Recognizing these limititions, there is no convincing evidence to suggest that maternal Lyme disease causes any clinically recognizable cardiac or neurologic adverse pregnancy outcomes.
--------------------------
4. Gestational Lyme borreliosis. Implications for the fetus.
AUTHORS:
MacDonald AB
AUTHOR AFFILIATION:
Southampton Hospital, New York.
ABSTRACT:
Great diversity of clinical expression of signs and symptoms of gestational Lyme borreliosis parallels the diversity of prenatal syphilis. It is documented that transplacental transmission of the spirochete from mother to fetus is possible. Further research is necessary to investigate possible teratogenic effects that might occur if the spirochete reaches the fetus during the period of organogenesis. Autopsy and clinical studies have associated gestational Lyme borreliosis with various medical problems including fetal death, hydrocephalus, cardiovascular anomalies, neonatal respiratory distress, hyperbilirubinemia, intrauterine growth retardation, cortical blindness, sudden infant death syndrome, and maternal toxemia of pregnancy. Whether any or all of these associations are coincidentally or causally related remains to be clarified by further investigation. It is my expectation that the spectrum of gestational Lyme borreliosis will expand into many of the clinical domains of prenatal syphilis.
NLM PUBMED CIT. ID: 2685924 NLM CIT. ID: 90069113
SOURCE:
Rheum Dis Clin North Am 1989 Nov;15(4):657-77
Hei, olen kirjoittamassa aiheesta artikkelia kotisivuillemme (todennäköisesti vasta syksyllä). Asiaa on tutkittu jonkin verran maailmalla ja sen lisäksi vanhemmat kertovat asiasta esim. eri maiden keskustelupalstoilla. Tapasin aikoinaan Amerikassa muutamia vanhempia, joiden lapset sairastivat borrelioosia joko syntymästä saakka tai nuoresta pitäen. Yhdessä perheessä 4 lasta sairasti borrelioosia. Lapsien oireet olivat alkaneet eri ikäisinä. Äiti oli vakuuttunut että lapset olivat saaneet taudin häneltä jo raskauden aikana. Myös muutamalla yhdistyksemme jäsenellä on asiasta henkilökohtaisia kokemuksia.
Tutkimuksissa borreliabakteereita on löydetty äidinmaidosta, emättimestä, miehen siemennnesteestä jne. ja bakteeri kykenee siirtymään istukasta sikiöön. Eläimillä on todettu borrelioosista johtuvia sikiökuolemia ym. Joitakin tapauksia on tavattu myös ihmisillä.
Tutkimuksissa näkyy pääasiassa borreliabakteerin välittömät seuraukset kuten keskenmenot ja synnynnäiset epämuodostumat jne. Sitä ovatko lapsen myöhemmässä elämässä ilmenevät terveysongelmat mahdollisen borreliainfektion aiheuttamia, ei ole tietääkseni tutkittu. Asiaa olisikin vaikea tutkia sillä oireet voivat johtua esim. myöhemmällä iällä saadusta infektiosta. Olemassaolevien tutkimusten pohjalta vaikuttaisi kuitenkin siltä, ettei lapsella ole kovin suurta riskiä sairastua, vaikka äiti sairastaisikin borrelioosia raskauden aikana.
Ps. Mikäli haluat asiasta lisää tutkimuksia, voit kirjoittaa/soittaa minulle. Yhteystietoni ovat kotisivuilla.
Seuraavassa muutamia tutkimuksia:
1. Teratogen Update: Lyme Disease
Teratology 64:276?281,2001.
DANIEL J. ELLIOTT,1 STEPHEN C. EPPES,2 AND JOEL D. KLEIN2*
1 Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
2 Department of Pediatrics, Division of Infectious Disease, A I duPont Hospital for Children,
Wilmington, Delaware 19899
ABSTRACT We reviewed the world literature concerning the reproductive effects of Lyme disease (LD). Borrelia burgdorferi, which is the etiology of LD, is a spirochete and, as such, may share the potential for causing fetal infection, which may occur in the setting of maternal spirochetemia. Information concerning the effects of gestational LD derives from case reports and series, epidemiologic studies, and experimental animal models. Although provocative, these studies fail to define a characteristic teratogenic effect. However, skin and cardiac involvement have predominated in some reports. Pregnancy wastage has been suggested primarily by animal studies. Gestational LD appears to be associated with a low risk of adverse pregnancy outcome, particularly with appropriated antibiotic therapy. Suggestions for management of clinical situations are presented. Teratology 64:276?281, 2001. © 2001 Wiley-Liss, Inc.
DISCUSSION
Attempts to define the clinical significance of gestational Lyme disease have been limited seriously by several factors.
First, the prevalence of Lyme disease in pregnant women, even in highly endemic regions, is low, making it difficult to perform statistically significant case-control and other epidemiological based studies.
Second, it is difficult to define B. burgdorferi infection, especially in the absence of clinical markers such as EM.
Studies relying on LD seropositivity, a history of a tick bite, or even retrospective clinical history are unreliable in diagnosing LD in pregnant women and may make studies of gestational LD questionable.
Third, owing to increased awareness and concern about Lyme disease, particularly in pregnant patients, most will have received
antibiotic treatment.
For these reasons, our understanding of the outcome of untreated gestational Lyme disease is based on a small number of case reports and pathological studies that in some instances occurred without the benefit of accurate diagnostic techniques.
Despite these limitations, it is possible to address several aspects of gestational Lyme disease.
First, does B. burgdorferi cross the placenta and invade the fetus?
Second, if there is transplacental transmission, does this have any significance for the development of the fetus? Finally, is there an overall effect on pregnancy without regard to direct fetal infection?
Studies in both human and animal models have established that B. burgdorferi can cross the placenta, presumably occurring during a period of spirochetemia.
The clinical significance of transplacental transmission in humans remains unclear, however given the absence of a documented fetal inflammatory or immunologic response, which would be expected if the spirochetes were causing active infection. Perhaps the most compelling argument against the teratogenicity of gestational Lyme disease is the lack of a consistent clinical outcome in affected pregnancies.
Initially the most concerning potential associations involved congenital cardiac malformations and fetal loss.
Subsequent epidemiologic research has cast significant doubt on this association. The relationship between gestational Lyme disease and fetal loss also remains unclear. Because gestational Lyme disease has been clearly linked to fetal loss in animal studies, the potential for a causal effect in human gestational LD exists.
A connection between fetal and maternal infection in humans with other spirochetes, such as Borrelia recurrentis and Leptospira canicola has been demonstrated (Gaud et al., ?47; Coghlan, ?69).
Despite documentation of transplacental transmission of Borrelia burgdorferi, there has been no evidence for a fetal inflammatory or immune response or a consistent clinical outcome resulting from gestational Lyme disease. An analysis of current evidence, therefore, indicates that an adverse fetal outcome due to maternal infection with B. burgdorferi at any point during pregnancy in humans is at most extremely rare.
--------------------
2. Strobino B, et al. Maternal Lyme disease and congenital heart disease: a case-control study in an endemic area. Am J Obstet Gynecol. 1999;180:711-716.
A follow-up to the study above which used patients form the same endemic geographical area. Cases and controls were 7 year old (or less) patients of a large pediatric cardiology service. There was a 39% maternal response rate of a questionnaire that obtained perinatal information.
Maternal characteristics and exposures were comparable. Criteria for Lyme disease was either characteristic symptoms or diagnosis by a physician.
For purposes of analysis, Lyme disease before or during pregnancy was considered a single exposure category. There was no association between Lyme disease before or during pregnancy and congenital heart disease.
-------------------------
3. Silver HM. Lyme disease during pregnancy. Infectious Disease Clinics of North America. 1997;1:93-97.
A literature review which included the citations referenced above (excepting the 1999 study).
Reference was made to a 1986 CDC study which reviewed outcomes of 19 pregnancies complicated by Lyme disease. Five had abnormal outcomes which included fetal death, cortical blindness, vesicular rash, preterm delivery, and syndactyly.
A Swiss study reported VSD in the infant of a mother with untreated Lyme disease. "As the (Lyme) disease is uncommon, and anomalies less common, larger epidemiologic studies are required for a definitive resolution to the question of fetal risks with perinatal infection."
Conclusions: There have been isolated case reports of a variety of congenital malformations following maternal Lyme disease during pregnancy. Epidemiologic evidence thus far has not completely answered the question whether or not these associations are related to Lyme disease or to chance occurrence. Part of the problem is that it is difficult to retrospectively diagnose Lyme disease. This is because it is possible to have characteristic symptoms without an antibody response and vice versa. Another problem is that some investigators combine Lyme disease before or during pregnancy as an exposure category. Recognizing these limititions, there is no convincing evidence to suggest that maternal Lyme disease causes any clinically recognizable cardiac or neurologic adverse pregnancy outcomes.
--------------------------
4. Gestational Lyme borreliosis. Implications for the fetus.
AUTHORS:
MacDonald AB
AUTHOR AFFILIATION:
Southampton Hospital, New York.
ABSTRACT:
Great diversity of clinical expression of signs and symptoms of gestational Lyme borreliosis parallels the diversity of prenatal syphilis. It is documented that transplacental transmission of the spirochete from mother to fetus is possible. Further research is necessary to investigate possible teratogenic effects that might occur if the spirochete reaches the fetus during the period of organogenesis. Autopsy and clinical studies have associated gestational Lyme borreliosis with various medical problems including fetal death, hydrocephalus, cardiovascular anomalies, neonatal respiratory distress, hyperbilirubinemia, intrauterine growth retardation, cortical blindness, sudden infant death syndrome, and maternal toxemia of pregnancy. Whether any or all of these associations are coincidentally or causally related remains to be clarified by further investigation. It is my expectation that the spectrum of gestational Lyme borreliosis will expand into many of the clinical domains of prenatal syphilis.
NLM PUBMED CIT. ID: 2685924 NLM CIT. ID: 90069113
SOURCE:
Rheum Dis Clin North Am 1989 Nov;15(4):657-77