I know Lyme patients my age who got the disease from their mother in utero because their mother did not know that they were bitten by a tick during their pregnancy, or did not know that they were carrying Lyme disease prior to getting pregnant. There are many unfortunate and heartbreaking stories like this, most recently the story of John Cauldwell and his entire family being diagnosed with the disease. Lyme disease is such a stealth pathogen that women with vague symptoms can have no idea that they are ill, and through no fault of their own unknowingly transmit it in utero. This is why it is so important for women who do know they currently have Lyme disease to get pregnant only under the care and advice of a Lyme literate doctor. But we will cover this topic and others more in depth below.
If you are a healthy pregnant mother who gets bit by a tick during your pregnancy, what should you do?
This is an issue that most LLMD's agree on with the CDC, and they both stress that prompt treatment is necessary as there are grave risks for your unborn baby. The CDC says: "Untreated, Lyme disease can be dangerous to your unborn child. Lyme disease that goes untreated can also cause you to have brain, nerve, spinal cord, and heart problems. With early treatment these complications can be prevented. If you suspect you may have Lyme disease, see your physician (5)." I would like to however add the edit of "please see a Lyme literate physician," and that's because the CDC only recommends 2-4 weeks of antibiotics, which we now know is not sufficient enough.
A Lyme literate physician will be able to help in the initial treatment and also follow you along the entire pregnancy afterwards to make sure that your baby stays healthy throughout. The other benefit is that after pregnancy you have a Doctor who knows what to look out for going forward postpartum if Lyme disease persists.
What are the risks to the baby if the mother does not seek treatment? Dr. Daniel Cameron MD detailed many different findings of such situations. Studies found that stillbirths occurred when the disease was contracted during the first trimester. Gestational Lyme Borreliosis was described in 5 of 19 pregnancies studied, resulting in cortical blindness, intrauterine fetal death, and rash (1-3). Another report attributes an infant death at one week old to a transmission of Bb from the mother, after the autopsy showed evidence of spirochetes in the spleen, kidneys, and bone marrow (2). A third report detailed a newborn death at 39 hours of life, with a left side hypoplastic heart and the presence of spirochetes also in the spleen, kidneys, and bone marrow. Borrelia was also able to be cultured from fetal liver tissue in 4 stillborn infants (4).
These findings prove the presence of Borrelia in the baby and go on to emphasize why treatment when bit by a tick during pregnancy calls for prompt measures. A Lyme literate doctor will work with you to find the right antibiotic regimen, and it is typically any combination of Amoxicillin, Cefuroxime, Azithromycin, and IV Ceftriaxone. All of these are safe for pregnant women.
Could I get pregnant if I already have Lyme disease? Is it safe, and can I give birth to a healthy baby?
For this question I consulted different physicians who are very well versed in treating chronic Lyme disease and have experience in this arena. One of these physicians is Dr. Marty Ross MD, who has his own Lyme practice and provides care to pregnant mothers. Dr. Ross advises that women with Lyme Disease can get pregnant, but they must know the risks and must take steps to prevent transmission. Lyme symptoms will typically improve during the pregnancy and worsen after delivery.
There is no single study which has followed large numbers of women to determine the actual Lyme transmission rate. However a review was conducted by T Gardner in 2001 and published in the Infectious Disease and Newborn Infant 5th edition. Gardner looked at 263 cases of pregnancy outcomes where Lyme was involved and found that 66 fetuses had Lyme. This suggested an approximate 25% transmission rate in pregnancy. However, this was a very small batch study, and it is likely that the actual amount could be much higher.
So what can be done to ensure that the Lyme disease does not transmit to the baby? The common treatment is for mothers to take antibiotics during the entire pregnancy. Dr. Charles Ray Jones MD, the leading pediatric Lyme Literate physician, followed 160 pregnant women with Lyme who took antibiotics before & during pregnancy. Of these 160 women, 5% of the babies born had laboratory evidence of Lyme transmission (in placenta cords or foreskin). These babies were treated, and afterwards all 160 women went on to have healthy infants.
The Lyme Disease Foundation in Hartford, CT also had similar encouraging results. The foundation kept a pregnancy registry for 11 years, beginning in the late 1980's. They found that if patients were maintained on adequate doses of antibiotic therapy during gestation then no babies were born with Lyme disease. Dr. Joseph Burrascanno MD, another leading LLMD mirrored this sentiment, and said that his experience over the last 20 years agrees with those findings.
The consensus seems to be that you can safely have a baby when you have Lyme disease, but it absolutely requires necessary precautions. You need to be able to commit to antibiotic therapy before conception and all the way through the pregnancy. This is something your LLMD will discuss with you so that you are prepared to make the commitment and ensure a healthy birth and a healthy infant. You also need to be prepared that symptoms typically flare considerably postpartum, and planning for that is also very important. If you have an unexpected pregnancy then make an appointment with your LLMD immediately, so you can get started on adequate antibiotic therapy as soon as possible.
Can Lyme Disease be found in breast milk?
According to Dr. Joseph Burrascanno MD, the answer is yes. Breast milk from infected mothers has been shown to harbor spirochetes that can be detected by PCR and grown in cultures.
- Markowitz LE, Steere AC, Benach JL, Slade JD, Broome CV. Lyme disease during pregnancy. Jama, 255(24), 3394-3396 (1986).
- Schlesinger PA, Duray PH, Burke BA, Steere AC, Stillman MT. Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi. Ann Intern Med, 103(1), 67-68 (1985).
- MacDonald AB, Benach JL, Burgdorfer W. Stillbirth following maternal Lyme disease. N Y State J Med, 87(11), 615-616 (1987).
- MacDonald AB. Human fetal borreliosis, toxemia of pregnancy, and fetal death. Zentralbl Bakteriol Mikrobiol Hyg A, 263(1-2), 189-200 (1986).