Lyme Disease During Pregnancy and Breastfeeding: What to Know
Can Lyme disease affect pregnancy or be passed to a baby?
Possibly. While many pregnancies have normal outcomes, some studies suggest that untreated Lyme disease during pregnancy may increase the risk of complications.
Early recognition and appropriate treatment are important for reducing risk.
For a broader overview, see Lyme disease symptoms.
Lyme Disease and Pregnancy
If a woman develops Lyme disease during pregnancy, prompt medical evaluation is recommended.
Some studies have described adverse pregnancy outcomes, particularly when infection occurs early in pregnancy.
- Stillbirth has been reported in first-trimester infections
- Cases of prematurity and fetal abnormalities have been described
- Reported findings have included syndactyly, cortical blindness, and rash
In one report, spirochetes consistent with Borrelia burgdorferi were identified in fetal tissues.
However, not all studies have shown increased pregnancy risk.
A large study involving approximately 2,000 women with prior Lyme disease did not identify increased rates of fetal death or low birth weight.
This suggests that outcomes may depend on timing of infection, treatment, co-infections, and individual immune response.
Can Lyme Disease Be Transmitted During Pregnancy?
Transmission of Lyme disease from mother to fetus has been reported in some published cases, but the overall frequency remains uncertain.
There is currently insufficient evidence to determine how often congenital transmission occurs.
Early diagnosis and treatment appear to reduce the likelihood of complications.
Researchers continue to debate the long-term implications of Lyme disease during pregnancy because available studies remain limited and sometimes conflicting.
Antibiotic Treatment During Pregnancy
Choosing antibiotics during pregnancy requires individualized medical judgment.
Medications sometimes used during pregnancy include:
- Amoxicillin
- Cefuroxime
- Azithromycin
- Intravenous ceftriaxone in selected neurologic or disseminated cases
Certain antibiotics may be avoided during pregnancy because of potential fetal risk.
Treatment decisions should be individualized and guided by the patient’s clinician.
Breastfeeding and Lyme Disease
Can Lyme disease be transmitted through breast milk?
According to the CDC, there are no confirmed reports of Lyme disease transmission through breastfeeding.
However, published data remain limited.
Certain antibiotics—particularly tetracyclines—may require additional consideration during breastfeeding because of potential infant exposure.
Breastfeeding decisions should be individualized and discussed with a clinician familiar with Lyme disease management.
I have seen differing opinions among clinicians regarding breastfeeding during Lyme disease treatment, particularly in patients with persistent illness or co-infections.
Babesia and Pregnancy
Babesia infection, another tick-borne illness, has been transmitted from mother to infant during pregnancy.
Cases have been reported in which newborns developed Babesia infection weeks after birth.
This highlights the importance of considering tick-borne co-infections during pregnancy evaluation.
Babesia may present additional pregnancy-related risks because it infects red blood cells and may affect both mother and infant.
Why Lyme Disease During Pregnancy Remains Complex
Research involving Lyme disease during pregnancy remains limited and sometimes contradictory.
- Some studies report increased complications
- Others report outcomes similar to the general population
- Long-term developmental outcomes remain insufficiently studied
Differences in study design, timing of diagnosis, treatment approaches, and co-infections may contribute to conflicting conclusions.
This uncertainty makes individualized clinical care especially important.
Frequently Asked Questions
Can Lyme disease affect pregnancy?
Possibly. Some studies suggest untreated Lyme disease during pregnancy may increase the risk of complications.
Can Lyme disease be transmitted to the baby?
Congenital transmission has been reported in some cases, but the overall frequency remains unclear.
Can pregnant women be treated for Lyme disease?
Yes. Antibiotics such as amoxicillin, cefuroxime, azithromycin, and ceftriaxone may be considered depending on the clinical situation.
Can Lyme disease be transmitted through breast milk?
There are currently no confirmed reports of Lyme disease transmission through breastfeeding, although data remain limited.
Why is Babesia important during pregnancy?
Babesia has been transmitted from mother to infant during pregnancy and may represent an important co-infection risk.
Clinical Takeaway
Lyme disease during pregnancy requires prompt recognition, careful monitoring, and individualized treatment decisions.
While many pregnancies have normal outcomes, delayed diagnosis and untreated infection may increase the risk of complications.
I have seen significant concern among patients regarding both breastfeeding and co-infections such as Babesia, particularly when symptoms persist during or after pregnancy.
Early diagnosis, individualized treatment, and careful follow-up remain important for both mother and child.
Related Articles
Lyme Disease Misdiagnosis
Prevention of Lyme Disease
Pediatric Lyme Disease
Autonomic Dysfunction in Lyme Disease
Post-Treatment Lyme Disease Syndrome (PTLDS)
References
- MMWRCurrent Trends Update: Lyme Disease and Cases Occurring during Pregnancy — United States
- Markowitz LE, Steere AC, Benach JL, Slade JD, Broome CV. Lyme disease during pregnancy. JAMA. 1986;255(24):3394-3396.
- MacDonald AB. Gestational Lyme borreliosis: implications for the fetus. Rheum Dis Clin North Am. 1989;15(4):657-677.
- Williams CL, Strobino B, Weinstein A, et al. Maternal Lyme disease and congenital malformations: a cord blood serosurvey in endemic and control areas. Paediatr Perinat Epidemiol. 1995;9(3):320-330.
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
Interesting, that is not what I was told when I was pregnant. I was being treated by one of the top Lyme Doctors(He is no longer practicing but may still be doing research) and he was very clear that breastfeeding was not an option. He also indicated that most women feel great during pregnancy and had a horrible time after. My kids are 22, 19, and 15 and I was told I could not breastfeed. During my first pregnancy, I was not on antibiotics and after the pregnancy, I had a horrible relapse. In my other two pregnancies, I was on antibiotics and did not have nearly the same reaction. I would be curious as to what has warranted the change of thinking esp since the number of mothers and studies seem rather low. Overall, I have trouble trusting the CDC when it comes to anything related to Lyme and tick borne diseases. I hope the experts in the field are not relying only on the CDC
I have not seen published data to advise my patients not to breast feed. I have colleagues who continued to advise their patients not to breast feed. There advise could be out of cases they have seen or an abundance of concern. I choose to discuss options with the mother and father until data is available.