Can Lyme Disease Be Passed to a Baby During Pregnancy?
Can Lyme disease affect an unborn baby?
Congenital transmission appears uncommon but has been reported.
Prompt treatment improves pregnancy outcomes.
Can Lyme disease be passed to a baby during pregnancy? This is one of the most common questions asked by pregnant women diagnosed with Lyme disease. Although published reports have described possible maternal-fetal transmission of Borrelia burgdorferi, available evidence suggests this appears to be uncommon, particularly when Lyme disease is recognized and treated promptly with recommended antibiotics.
Because research remains limited, clinicians generally recommend early diagnosis, appropriate antibiotic treatment, and close obstetric follow-up for pregnant women with Lyme disease.
Can Lyme disease cross the placenta?
The first confirmed case of Lyme borreliosis (LB) in a pregnant woman was described in 1985 in a 28-year-old woman who developed Lyme disease during the first trimester, according to Schlesinger and colleagues.2
The mother developed symptoms consistent with Lyme disease after delivery, confirmed by a positive immunofluorescence assay. The infant died from congenital heart disease. During the autopsy, investigators identified spirochetes infiltrating the spleen, kidneys, and bone marrow, although not the cardiac tissue.
Because this was a single case report, it cannot determine how frequently maternal-fetal transmission occurs. Nevertheless, it raised important questions about the possibility of congenital Lyme disease and led to additional research.
Since that report, additional studies have generally found favorable pregnancy outcomes among women treated appropriately for Lyme disease, although larger prospective studies are still needed.
Subsequent reports have described pregnancy complications associated with maternal Lyme borreliosis, including stillbirth and possible congenital abnormalities, although a direct causal relationship has not been established in every case.
As Trevisan and colleagues wrote, “Complications of maternal Lyme borreliosis in pregnancy outcomes have been already reported, including stillbirth and possible congenital malformations.”
The authors also noted that Borrelia-specific antibodies have been detected in the cerebrospinal fluid of an infant with documented neurologic dysfunction, further supporting the need for continued research into congenital Lyme disease.
Case series of 11 pregnant women with Lyme disease
“Pregnant women are considered a vulnerable group due to a weakened immune system. Therefore, they are more susceptible to infection with an increased risk for severe illness…and infections in pregnant women have the added gravity of potential infection in the developing fetus.”¹
Trevisan and colleagues evaluated 11 pregnant women diagnosed with Lyme borreliosis.
- Five women were diagnosed during the first trimester.
- Three were diagnosed during the second trimester.
- Three were diagnosed during the third trimester.
The clinical presentations varied considerably.
- Six women developed erythema migrans between weeks 8 and 34 of pregnancy.
- Three developed musculoskeletal symptoms.
- One experienced neurologic involvement.
- Two women had positive Lyme serology without clinical symptoms.
All patients except one had positive laboratory testing. The exception was a 26-year-old woman whose erythema migrans rash established the diagnosis despite negative serology, illustrating that Lyme disease remains a clinical diagnosis, particularly early in infection.
This case also illustrates why erythema migrans should be diagnosed clinically and not delayed while waiting for positive laboratory testing.
Treatment during pregnancy
All mothers received amoxicillin 1 gram three times daily for 14 days.
Current treatment recommendations generally favor amoxicillin for early Lyme disease during pregnancy. Prompt treatment is considered important to reduce maternal illness and may lower the risk of adverse pregnancy outcomes. Learn more about treatment options for Lyme disease.
At one-year follow-up, 10 of the 11 women were healthy. One woman with persistent joint and neurologic symptoms improved only partially after amoxicillin and later required intravenous ceftriaxone because of ongoing symptoms.
Pregnancy outcomes
Overall, pregnancy outcomes were favorable.
- One infant was born prematurely at seven months.
- One infant developed angiomatoid skin patches that resolved spontaneously by 18 months.
- All remaining infants were born healthy.
Although this case series is reassuring, its small size means larger prospective studies are still needed to better define the risks associated with Lyme disease during pregnancy.
Can a baby be born with Lyme disease?
Maternal-fetal transmission of Borrelia burgdorferi has been reported, but the available evidence does not establish how often it occurs. The published literature consists largely of case reports, small case series, and retrospective studies rather than large prospective trials.
Most women who are diagnosed and treated appropriately for Lyme disease during pregnancy deliver healthy infants. Nevertheless, the historic detection of spirochetes in fetal tissues supports prompt treatment and appropriate follow-up when Lyme disease develops during pregnancy.
Monitoring pregnant women and newborns
Trevisan and colleagues recommended that pregnant women with Lyme borreliosis be treated and followed clinically, with attention to possible skin, joint, neurologic, ocular, and cardiac manifestations.
Depending on the mother’s clinical presentation, additional fetal monitoring, including fetal echocardiography, may be considered by the obstetric care team.
The authors also recommended examining newborns for possible clinical abnormalities. Previous reports have described infants who were small for gestational age or had findings such as skin eruptions, vascular skin lesions, neurologic abnormalities, muscle hypotonia, hypospadias, pyloric stenosis, or skeletal abnormalities. However, these reports do not establish that Lyme disease caused each finding.
Longer-term follow-up studies are needed to better understand developmental outcomes after maternal Lyme disease.
Babesia can also be transmitted during pregnancy
Pregnant women with tick exposure should also be evaluated for possible tick-borne co-infections when clinically appropriate. Unlike Lyme disease, congenital babesiosis has been documented in multiple published case reports, providing stronger evidence for maternal-fetal transmission.
Babesia is a separate infection and requires different testing and treatment. Amoxicillin and other antibiotics used for Lyme disease do not treat babesiosis. Learn more about congenital babesiosis during pregnancy.
Frequently Asked Questions
Can Lyme disease be passed from mother to baby?
Maternal-fetal transmission of the Lyme disease bacterium has been reported, including detection of spirochetes in fetal tissues. However, the available evidence does not establish how frequently transmission occurs, and most women treated appropriately during pregnancy deliver healthy infants.
Is Lyme disease dangerous during pregnancy?
Untreated Lyme disease may pose risks to the mother and could potentially affect the pregnancy. Prompt diagnosis and recommended antibiotic treatment are important. Published studies have reported favorable outcomes in most women who received appropriate treatment.
What antibiotic is used for Lyme disease during pregnancy?
Amoxicillin is commonly used to treat early Lyme disease during pregnancy. The antibiotic, dose, route, and duration should be individualized according to the clinical presentation and the treating clinician’s assessment.
Can Lyme disease cause birth defects?
Possible congenital abnormalities have been described in individual reports, but the evidence does not establish that Lyme disease directly caused these findings. Larger prospective studies are needed to determine whether maternal Lyme disease increases the risk of specific congenital abnormalities.
Can you be born with Lyme disease?
Maternal-fetal transmission of Borrelia burgdorferi has been reported, so congenital Lyme disease may be possible. However, the available evidence does not establish how commonly this occurs, and most appropriately treated pregnancies have favorable outcomes.
Clinical Takeaway
Lyme disease during pregnancy should be recognized and treated promptly. Although maternal-fetal transmission has been reported, the available evidence does not show how frequently it occurs, and most appropriately treated pregnancies have favorable outcomes.
Pregnant women with Lyme disease should receive appropriate antibiotic treatment and coordinated obstetric follow-up, while newborns should be examined for any unexpected clinical findings.
Related Articles
Can Lyme disease impact pregnancy outcome?
Baby boy diagnosed with congenital babesiosis
Early Lyme disease symptoms and diagnosis
References
- Trevisan G, Ruscio M, di Meo N, et al. Case Report: Lyme Borreliosis and Pregnancy—Our Experience. Front Med (Lausanne). 2022;9:816868. doi:10.3389/fmed.2022.816868.
- Schlesinger PA, Duray PH, Burke BA, Steere AC, Stillman MT. Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi. Ann Intern Med. 1985;103(1):67–68. doi:10.7326/0003-4819-103-1-67.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I was 17 weeks pregnant in 2004 and was infected with LB. I was lucky my baby was born but has allergies I or any family member does not. I developed the rash and was given 250 mg of amoxicillin to take once a day. It’s a miracle my son even survived because there were no follow ups on LB treatment for us.
My son was born in 1998 with Lyme! I wasn’t aware that I had Lyme while I was pregnant, my pregnancy had many complications including a very long labor(48 hours). My Lyme was diagnosed by my son’s pediatrician Dr. Jones who referred me to a Specialist. My son was diagnosed at 3 weeks old.
Has anyone seen or described partial deafness or intractable tinnitus from neuro-Lyme in LB+ pregnant women or their infected offspring? Would such mothers benefit from iv ceftriaxone at full doses, in order to treat the cerebrospinal fluid, cranial nerves, and central nervous system?