We have reviewed the significant literature on the foetal transmission of Lyme disease.
Lyme disease is the most common vector-borne disease, typically spread by tick bites, specifically those of the Ixodes species. The incidence of Lyme borreliosis is steadily increasing, which may be due to a number of factors. One of these is the possibility of transmission from mother to foetus.
Confirmed transplacental infection
The first scientific evidence was reported in 1985, when Lyme infection was detected in a mother and her newborn baby, transmitted vertically. There is professionally substantiated evidence that Borrelia, the spirochete bacterium that causes Lyme disease, can be transmitted transplacentally from mother to foetus. Congenital infectious diseases have been mentioned in numerous books; the well-known acronym TORCH, which describes the most basic congenital infectious diseases, has been expanded to TORCHES-CLAP, where the letter L stands for Lyme disease. (T: toxoplasma, R: rubella, C: cytomegalovirus, H: herpes simplex, E: enterovirus, S: syphilis, C: chickenpox, L: Lyme, A: AIDS, P: parvovirus B19.)
Clinical studies, including autopsy data, have linked Lyme borreliosis during pregnancy to various health problems. Infection during any trimester of pregnancy can lead to foetal death, hydrocephalus, cardiovascular abnormalities, neonatal respiratory distress, hyperbilirubinaemia, intrauterine growth retardation, cortical blindness, sudden infant death syndrome, and maternal toxaemia during pregnancy.
Consequences and possible treatment
Dr. Tessa Gardner, a physician specialising in childhood infectious diseases, discovered during her research that of the 161 reports examined in connection with Lyme borreliosis during pregnancy, 46 cases had adverse outcomes, including miscarriage, stillbirth, perinatal death, congenital abnormalities, systemic disease, early-onset fulminant or mild sepsis, and later-onset chronic progressive infection. Of all adverse outcomes, 7 per cent were miscarriages or foetal deaths, 11 per cent were neonatal deaths, and 48 per cent were foetal or neonatal deaths. The effect of antibiotic therapy was dramatic in these patients: with antibiotics, 85% of newborns were normal, while 15% had an unfavourable outcome. In contrast, without antibiotics, only 33% were normal, while 67% had an unfavourable outcome.
However, according to pathologist Dr Alan MacDonald, the effects of the infection on the foetus need to be further investigated to determine the consequences of the pathogen reaching the foetus during organogenesis, for example.
A clinical study was conducted at the University Hospital of Trieste, where 11 pregnant women with Lyme borreliosis, with an average age of 30, were followed between 2008 and 2020. Six of them developed erythema migrans during pregnancy (between weeks 8 and 34), 3 developed myoarticular or neurological problems, and 2 had positive serology but no clinical symptoms. Their data emphasise the importance of early antibiotic treatment even in seropositive, asymptomatic pregnant women to avoid possible complications affecting the foetus and newborn.
Most common problems
Dr. Richard Horowitz is a leader in the treatment of tick-borne infections and has encountered complications due to transplacental transmission. Since experience shows that in some cases Borrelia survives a course of antibiotics in the body, he advises all women who wish to become pregnant – and who have a history of Lyme disease – to be tested for signs of persistent infection.
According to Charles Ray Jones, most children born with Lyme disease develop symptoms at birth or shortly thereafter. In his research, he found the following data regarding the frequency of symptoms:
| Percentage | Symptoms |
| 80 | Irritability |
| 80 | Cognitive problems, learning difficulties and mood swings |
| 72 | Fatigue and lack of stamina |
| 60 | Low fever, paleness and dark circles around the eyes |
| 50 | Arthritis and painful joints |
| 45 | Other rashes |
| 40 | Gastroesophageal reflux with vomiting and coughing |
| 40 | Frequent upper respiratory tract infections and otitis |
| 40 | Sensitivity to noise, light and skin |
| 30 | Eye problems: posterior cataracts, myopia, astigmatism, conjunctival erythema (Lyme eyes), optic nerve atrophy and optic nerve and/or uveitis |
| 30 | Haemangioma |
| 23 | Secondary rashes |
| 20 | abdominal pain |
| 18 | Developmental delay, including language and speech problems and hypotonia |
Several paediatric infectious disease specialists have drawn attention to the link between developmental disorders in children caused by Lyme disease and neuropsychiatric problems. Although there is growing evidence that Lyme disease can cause mental problems in newborns, the link between Lyme borreliosis or other tick-borne diseases and the development of neuropsychiatric symptoms is still a matter of debate.
One such retrospective study, which examined 102 pregnant women with Lyme borreliosis for neuropsychiatric symptoms, made the following findings:
| attention deficit disorder (56%) | speech delays (21%) | emotional instability (13%) |
| irritability or mood swings (54%) | anxiety (21%) | hearing/vision processing disorders (13%) |
| photophobia (43%) | writing and reading disorders (19%) | word selectivity disorders (12%) |
| poor memory (39%) | developmental delays (18%) | obsessive-compulsive disorder (11%) |
| hyperacusis (36%) | dyslexia (18%) | seizures (11%) |
| cognitive disorders (27%) | articulation disorders (17%) | involuntary athetoid movements (9%) |
| other sensory hypersensitivity (23%) | tic disorders (14%) | autism (9%) |
| anger or rage (21%) | depression (13%) | suicidal thoughts (7%) |
In the control group of 66 mothers with Lyme disease who were treated with antibiotics before conception and throughout their pregnancies, all gave birth to healthy babies. However, in the control group, there were eight pregnancies in which Borrelia burgdorferi and/or Bartonella henselae were detected in the placenta and umbilical cord.
Conclusion
Based on the experiences and research results described, we recommend screening women who are planning to become pregnant for Lyme infection – if they have a history of Lyme borreliosis or tick bites – and, if confirmed, antibiotic treatment from the second trimester onwards. Several antibiotics are currently available for pregnant women, so the risks associated with vertical transmission of Lyme borreliosis can be prevented without any side effects of the medication on the foetus.
Sources:
https://www.frontiersin.org/articles/10.3389/fmed.2022.816868/full
https://www.townsendletter.com/article/444-lyme-disease-gestational-transmission/4/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231644/
https://pubmed.ncbi.nlm.nih.gov/9067786/
https://pubmed.ncbi.nlm.nih.gov/2685924/
https://www.lymedisease.org/wp-content/uploads/2014/08/Image21-Gestational-Lyme-Studies.pdf
(C) Lyme Borreliosis Foundation
