Pregnancy, breast feeding and Lyme

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Welcome to another selection from my book “An Expert’s Guide on Navigating Lyme disease.” The book highlights the findings of my first 600 Lyme disease Science blogs.  In this episode, I will discuss pregnancy, breast feeding, and Lyme disease.

Pregnancy and breast feeding are particularly concerning topics for Lyme disease patients and their doctors. Here are few findings to help with discussions.

Pregnancy and Lyme.

If a woman is bit by a deer tick or contracts Lyme disease (LD) while pregnant, she must immediately alert her treating physician. Poor outcomes have been described for newborns whose mothers contracted Lyme disease during pregnancy.
Studies have found that stillbirths occurred when LD was contracted during the first trimester. Markowitz et al., 1986, Schlesinger et al., 1985, and MacDonald et al., 1987) Gestational Lyme borreliosis has been described in 5 of 19 pregnancies (26%) resulting in “syndactyly, cortical blindness, intrauterine fetal death, prematurity, and rash” (Markowitz et al., 1986).

A newborn died at 39 hours of life with a left-sided hypoplastic heart and the presence of spirochetes consistent with Bb [Borrelia burgdorferi] “in the spleen, kidneys, and bone marrow” (Schlesinger et al., 1985). Bb was also cultured from fetal liver tissue in 4 stillborn infants (MacDonald 1986). 
There was insufficient evidence to determine the risk to a child if their mother contracted Lyme disease before pregnancy (Mylonas 2011). A study of 2,000 women with a history of LD did not show an increased risk of fetal death, decreased birth weight, or length of gestation at delivery. There was an increase in the number of congenital defects but the risk may have been by chance alone (Strobino et al., 1993).

Choosing an antibiotic regimen for pregnant women with Lyme disease can be a complex challenge. Amoxicillin, cefuroxime, azithromycin, and IV ceftriaxone have been prescribed for pregnant women (Maraspin et al., 2009).

Author’s note: More studies will be needed to understand pregnancy and breast feeding concerns.

Breast feeding and Lyme.

The CDC addressed the question “Can Lyme disease be transmitted through breast milk?” They announced, “No reports of breast milk spreading Lyme disease to infants exist” (CDC 2022).
There is insufficient data to determine if breastfeeding can transmit Bb to the child. 
Certain antibiotic classes, such as tetracyclines, should not be used in breastfeeding women being treated for Lyme disease to avoid the risk of side effects, such as tooth discoloration. The child’s clinician can help guide treatment options for a breastfeeding mother. Read more.

Diversity of clinical presentations of Lyme and pregnancy.

Doctors followed 11 pregnant women with Lyme disease from 2008 to 2020. “In the present study, we report our case series, which includes 11 pregnant women, 6 of whom developed erythema migrans during pregnancy (between weeks 8 and 34), 3 had monoarticular or neurological symptoms, and 2 had positive serology but did not develop any clinical symptoms” (Trevisan et al., 2020).

All mothers were treated with amoxicillin 1g 3x/ day for 14 days. One child was born prematurely at seven months. Another child was born with angiomatoid patches that regressed spontaneously 18 months later. One of the pregnant women with Lyme disease, confirmed by spinal tap and labs, experienced articular and neurologic involvement and improved with amoxicillin. However, she required treatment with intravenous ceftriaxone because of persistent symptoms. Read more.

Two mothers transmit Lyme to their babies.

Babesia can be contracted from the bite of a deer tick, a blood transfusion, or during pregnancy. This podcast reviews a case in which Babesia was transmitted from mothers to their babies during pregnancy.

Questions raised in the podcast include: 
• How often do mothers contract Babesia from a tick bite during pregnancy?
• Is there an effective and safe treatment for Babesia in pregnant women?
• How does a mother or doctor recognize Babesia in a pregnant mother?
• Should doctors follow pregnant mothers with a tick bite or Lyme disease for Babesia and what evidence should be investigated? 
• Will the mothers develop complications of Babesia in the future if not treated?
• Should the two mothers have been treated for Babesia? Read more.

[bctt tweet=”Two mothers transmit Lyme to their babies.” username=”DrDanielCameron”]

A baby girl with Lyme disease.

Slovenian researchers investigated whether Borrelia burgdorferi bacteria, the pathogen causing Lyme disease, might impact pregnancy outcomes. 
Pregnancy outcome was unfavorable in 13.8% (42/304) of patients. They found that the outcome of pregnancy in Lyme disease patients was not significantly worse.

There were 22 pre-term births, 10 fetal/perinatal deaths, and/or 15 anomalies. Several mothers had potential explanations for their unfavorable pregnancy outcomes. The poor outcome for Lyme disease patients was not significantly different compared to the general population (Maraspin et al., 2020).

Author’s note: The study did not follow the 262 women who gave birth with a favorable outcome for any long-term problems. Nor did the authors describe the outcome for women who were not treated for early Lyme disease. Read more.

Little information on treatment of tick bites during pregnancy.

Smith et al., (2020) argue that “high-level evidence” supports using a single 200 mg dose of doxycycline for tick bites during pregnancy. The evidence they cited is not high-level. Instead, they focused on a small Meta-Analysis study.
Regrettably, there is no evidence that a single 200 mg dose of doxycycline prevents other manifestations of Lyme disease, such as heart block, 7th nerve palsy, Lyme arthritis, Lyme encephalopathy, or Neuropsychiatric Lyme disease. Read more.

Congenital transmission of Babesia to a 5-year-old twin.

A baby girl was born to a mother who showed no evidence of Lyme or a related tick-borne illness during her pregnancy (Walker et al., 2022). The 5-week-old female diamniotic dichorionic twin was born at 36 5/7 weeks by C-section and diagnosed with Babesia. Her twin brother was asymptomatic.
The mother described several trips to Cape Cod, Massachusetts, an area endemic to Lyme disease.

“The patient’s mother had one febrile illness during pregnancy, occurring at approximately 23-24 weeks of gestation, associated with a maculopapular rash that resolved spontaneously” (Walter et al., 2022). 
The daughter was treated with a blood transfusion, intravenous atovaquone twice daily, and azithromycin daily. The authors of the article pictured a blood smear with intraerythrocytic inclusions consistent with Babesia microti. Read more.

Delayed onset Babesia in two newborns.

A study from the Mayo clinic described two newborn infants diagnosed with Babesia several weeks after the mothers were treated for Lyme disease (Hoversten and Bartlett, 2018).
Infant 1:
A baby boy was diagnosed with Babesia at 4-1/2 weeks. His mother had been diagnosed and treated for early Lyme disease at 32 weeks gestation.
Infant 2: 
A baby girl was diagnosed with Babesia at 18-days-old. Her mother had been diagnosed and treated for early Lyme disease at 37 weeks gestation.
Neither mother was treated for Babesia during their pregnancy. Read more.