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Lyme and Pregnancy

A wide range of adverse pregnancy outcomes can be associated with Lyme disease in pregnancy. As reported by the CDC, NIH, WHO, Canadian Federal Health Authorities, and US Tick-Borne Disease Working Group, Lyme bacteria can be transmitted across placenta to fetus or baby leading to congenital and perinatal infections.

Cases of acute infection (tick bite and bull’s-eye rash in pregnancy) and subclinical (asymptomatic/no recall of a tick bite or bullseye rash in pregnancy) infection have been reported associated with fetal/infant infection.

Cases of babies with congenital Lyme infection have been reported. There have been several reports of the Lyme bacteria being found in stillborns and in infants born with severe abnormalities. Therefore, pregnant women should consider prompt treatment if suspected of having been infected.

A wide range of adverse pregnancy outcomes associated with Lyme and Pregnancy have been documented including:

  • spontaneous miscarriage and stillbirth
  • preterm delivery
  • early neonatal death
  • intrauterine growth restriction
  • clinical manifestations in the newborn ranging from low birth weight and hyperbilirubinemia (jaundice) to hypotonia (poor muscle tone), cortical blindness, developmental delay, cardiac and urinary tract defects, syndactyly, hydrocephalus, cavernous hemangioma, respiratory distress, neurologic dysfunction and newborn rash

Prompt treatment of Lyme disease in pregnancy is associated with good pregnancy outcomes. There are differing medical opinions regarding treatment for Lyme in pregnancy – ranging from oral antibiotics to IV antibiotics. However, there are reported cases of Lyme treatment during pregnancy in which Lyme infection was still identified in babies. The infants need to be monitored.

While there is no direct evidence to date that nursing mothers infected with Lyme disease transmit infection through their milk, a nursing mother, suspected of being infected, may want to consider discontinuing nursing until she has treatment. The infant should be observed for signs of infection and its blood tested for evidence of infection if illness develops.

Many health care professionals (including primary-care practitioners and OB-GYNs) may not be aware of this alternate mode of transmission. Pregnant women with Lyme (or those desiring to become pregnant) may have to advocate for assessment, treatment and monitoring of themselves and their baby during and after birth. If you are pregnant and suspect you have Lyme disease, we recommend you seek care from a Lyme-literate practitioner.

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