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Ultrasound

Lyme Disease in Pregnancy

NICE Guidance

 

The NICE guideline on Lyme disease, states "The committee acknowledged that mother-to-baby transmission of Lyme disease is possible in theory. There was an absence of evidence, but the risk appears to be very low."
Rationale-and-impact/Lyme disease/Guidance/NICE
 

NICE reviewed congenital transmission through a limited set of observational studies that report an incidence or prevalence estimate of Lyme disease through vertical transmission.
Persontoperson-transmission Lyme disease/Evidence/ Nice
 

 

US CDC Guidance

 

Congenital transmission of Lyme disease was first acknowledged by the US Centers for Disease Control in a communication from 1985 where they stated "Transplacental transmission of B. burgdorferi has been documented in a pregnant woman with Lyme disease who did not receive antimicrobial therapy”:
Current Trends Update: Lyme Disease and Cases Occurring during Pregnancy -- United States. MMWR Weekly, June 28, 1985. 34(25);376-8,383-4.
https://www.cdc.gov/mmwr/preview/mmwrhtml/00000569.htm
 

In it, they reference research by Schlesinger et al:
Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi. Ann Intern Med. 1985;103(1):67-8.Schlesinger PA, Duray PH, Burke BA, Steere

AC, Stillman MT.     https://pubmed.ncbi.nlm.nih.gov/4003991/
 

In January 2020, the CDC altered their guidance to indicate that there could be vertical transmission with negative consequences for the fetus, stating "Lyme disease acquired during pregnancy may lead to infection of the placenta and possible stillbirth. Therefore, early diagnosis and treatment of Lyme disease is important during pregnancy. However, no negative effects on the fetus have been found when the mother receives appropriate antibiotic treatment."


CDC guidance in 2024 states:
“Untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare. Fortunately, with appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes.* There are no published studies assessing developmental outcomes of children whose mothers acquired Lyme disease during pregnancy.”

“There are no reports of Lyme disease transmission through breast milk.”

 

The change of guidance in 2020 followed a systematic review of the evidence by Waddell et al. 

A systematic review on the impact of gestational Lyme disease in humans on the fetus and newborn - PubMed

 

 

The specific studies quoted in the review include:
 

  • Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy. The Pediatric Infectious Disease Journal. 1988;7(4):286-9.Weber K, Bratzke HJ, Neubert U, Wilske B, Duray PH.
    https://pubmed.ncbi.nlm.nih.gov/3130607/
     

  • Clinical features of early erythema migrans disease and related disorders. Zentralbl Bakteriol Mikrobiol Hyg A. 1986;263(1-2):209‐228.Weber K, Neubert U.
    https://pubmed.ncbi.nlm.nih.gov/3577481/


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Further Information

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