Can Lyme Disease During Pregnancy Affect Pregnancy Outcomes?
Lyme disease during pregnancy
Erythema migrans and antibiotic treatment
Pregnancy outcomes and unanswered questions
Can Lyme disease during pregnancy affect pregnancy outcomes? Researchers in Slovenia followed 304 pregnant women with early Lyme disease who were treated with antibiotics to better understand pregnancy outcomes. In their article, Course and Outcome of Erythema Migrans in Pregnant Women, Maraspin and colleagues describe the pregnancy course and outcomes for these women after treatment for early Lyme disease.[1]
All of the women had been diagnosed with Lyme disease based on the presence of an erythema migrans (EM or bull’s-eye) rash. They were evaluated before antibiotic treatment was initiated, then 2 weeks later, followed by 2-, 6-, 12-, and 18-month follow-up visits.
At the first visit, 98% of patients were treated with intravenous ceftriaxone (2 g once daily). The remaining patients received either intravenous penicillin G (10,000,000 units twice daily) or oral phenoxymethylpenicillin (1 g three times daily). Patients received a 14-day course of antibiotics.
Because the study included only women who received antibiotic treatment, it cannot determine pregnancy outcomes for women with untreated early Lyme disease.
Pregnancy outcomes following Lyme disease treatment
The outcome of pregnancy was unfavorable in 13.8% (42 of 304) of patients, the authors report. There were 22 preterm births, 10 fetal or perinatal deaths, and 15 congenital anomalies. However, several mothers had other potential explanations for their unfavorable pregnancy outcomes.
The rate of unfavorable pregnancy outcomes among women with Lyme disease was not significantly different from that of the general population. Still, the authors warned that “multivariable analyses showed that patients who develop EM in the early stages of pregnancy might have a higher risk of unfavorable outcome.”
Most pregnancies resulted in healthy deliveries, but the authors emphasized that larger studies are needed to better understand whether Lyme disease itself contributed to the unfavorable outcomes observed in some patients.
The authors concluded that pregnancy outcomes were generally favorable following treatment of early Lyme disease with a 2-week course of antibiotics, although women who developed erythema migrans early in pregnancy may have had a higher risk of unfavorable outcomes.
[bctt tweet=”We still need more research on Lyme disease in pregnancy.” username=”DrDanielCameron”]
Lyme disease, pregnancy, and fertility
Meanwhile, another study of 2,000 women with a history of Lyme disease did not demonstrate an increased risk of fetal death, decreased birth weight, or shorter gestation at delivery.[2] In the same study of 2,000 women, however, a history of a tick bite within 3 years of conception was associated with congenital defects.
The Maraspin study focused on pregnancy outcomes in women with early Lyme disease and erythema migrans. It did not evaluate whether Lyme disease affects fertility or infertility risk.
Editor’s note
The authors enrolled only women with early Lyme disease. Maraspin and colleagues did not follow the 262 women who had favorable pregnancy outcomes to determine whether there were any long-term health concerns in their children. Nor did they describe pregnancy outcomes for women who were not treated for early Lyme disease.
Because the findings were based on a case series rather than a randomized trial, the results should be interpreted cautiously. Larger studies are needed to determine whether Lyme disease itself contributed to any preterm birth, fetal or perinatal death, or congenital anomaly observed in this cohort.
Frequently Asked Questions
Can Lyme disease during pregnancy affect pregnancy outcomes?
Possibly. In this study of 304 treated pregnant women with erythema migrans, pregnancy outcomes were generally favorable overall. However, unfavorable outcomes occurred in 13.8% of patients, and women who developed erythema migrans early in pregnancy may have had a higher risk of an unfavorable outcome.
Is Lyme disease treatment during pregnancy important?
Yes. This study evaluated women who were treated for early Lyme disease during pregnancy. Most received intravenous ceftriaxone, and the authors concluded that pregnancy outcomes were generally favorable following a 2-week course of antibiotic therapy.
Can Lyme disease cause infertility?
Current evidence has not established that Lyme disease causes infertility. This study focused on pregnancy outcomes after women developed early Lyme disease, not on fertility. Additional studies are needed to determine whether Lyme disease affects fertility.
What should I do if I get a tick bite while pregnant?
If you are bitten by a tick during pregnancy, remove the tick promptly and contact your healthcare provider for guidance. Medical evaluation is especially important if you develop an erythema migrans rash, fever, fatigue, joint pain, or other symptoms after the bite.
Can Lyme disease be passed during pregnancy?
Adverse pregnancy outcomes have been reported in the medical literature, but available studies have produced mixed findings. This study suggests that treated early Lyme disease during pregnancy was generally associated with favorable outcomes while also highlighting the need for additional research.
Clinical Takeaway
This study of 304 pregnant women with erythema migrans found that pregnancy outcomes were generally favorable following antibiotic treatment for early Lyme disease.
However, unfavorable outcomes—including preterm birth, fetal or perinatal death, and congenital anomalies—were observed in a minority of patients. Women who developed erythema migrans early in pregnancy may have had a higher risk of an unfavorable outcome.
Prompt recognition and treatment of Lyme disease during pregnancy remain important, while larger studies are needed to better define the risks of Lyme disease and optimize maternal and fetal outcomes.
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References
- Maraspin V, Lusa L, Blejec T, Ruzic-Sabljic E, Pohar Perme M, Strle F. Course and Outcome of Erythema Migrans in Pregnant Women. J Clin Med. 2020;9(8).
- Strobino BA, Williams CL, Abid S, Chalson R, Spierling P. Lyme disease and pregnancy outcome: a prospective study of two thousand prenatal patients. Am J Obstet Gynecol. 1993;169(2 Pt 1):367-374.
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
