Lyme disease is the most common vector-borne illness, which is typically transmitted by ticks – Ixodes species to be precise. The incidence of Lyme borreliosis is continuously increasing, which is caused by a number of factors. One of them is the transmission of Lyme disease from mother to foetus.
Proven transplacental infection
The first confirmed case was found in 1985, when they managed to detect vertically transmitted Lyme disease in a mother and her new-born child. Scientifically proven facts show that the bacteria that causes Lyme disease – Borrelia sp. – can infect the foetus via placenta. The list of infectious congenital disease has been mentioned in numerous books before; the well-known ’TORCH’ acronym, which includes the most common infectious congenital diseases, has been extended to ’TORCHES-CLAP’, where the ’L’ means Lyme disease. (T: toxoplasma, R: Rubeola, C: Cytomegalovirus, H: Herpes simplex, E: Enterovirus, S: Syphilis, C: Chiken pox, L: Lyme, A: AIDS, P: Parvovirus B19.)
The clinical trials, including the autopsy, connected gestational Lyme borreliosis with different health related issues. Lyme infections acquired in any of the trimesters can cause foetal death, hydrocephalus, cardiovascular anomalies, neonatal respiratory distress, hyperbilirubinemia, intrauterine growth retardation, cortical blindness, sudden infant death syndrome, and maternal toxaemia of pregnancy.
Consequences and possible treatment
During her research, Dr. Tessa Gardner, an infectious disease paediatrician found that out of 161 gestational Lyme borreliosis cases, 46 had adverse outcomes, such as miscarriage, stillbirth, perinatal death, congenital anomalies, systemic illness, early onset fulminant or mild sepsis and later-onset chronic progressive infection. 37 percent of all the adverse outcomes were miscarriages or foetal deaths, 11 percent were neonatal deaths and 48 percent were either foetal or neonatal deaths. The effects of the antibiotic therapy were dramatic in these patients: with antibiotics, 85 percent of the cases had normal, while only 15 percent of them had adverse outcomes. On the contrary, without antibiotics, only 33 percent of the cases had normal and 67 percent of them had adverse outcomes.
Regarding gestational Lyme borreliosis, according to Dr. Alan MacDonald, further research is necessary to investigate possible teratogenic effects that might occur if the spirochete reaches the foetus during the period of organogenesis.
Clinical trials were carried out at the Trieste University Hospital, where 11 women with gestational Lyme borreliosis, with an average age of 30 years, were monitored between 2008 and 2020. 6 of them developed erythema migrans during the pregnancy (between the 8th and the 34th weeks), 3 of them had myo-articular or neurological symptoms and in 2 cases serology tests were positive without any clinical symptoms. These data emphasize the importance of antibiotic treatment in cases of seropositive, asymptomatic pregnant women, so the possible adverse outcomes can be prevented.
Most frequent adverse outcomes
Dr. Richard Horowitz is a well-known authority in treatment of tick-borne illnesses and he had also encountered complications caused by transplacental infection. He suggests that every woman who plans to get pregnant – and had encountered Lyme-disease before – should get tested if the infections is still detectable in the body, because observations show that Borrelia can survive an antibiotic course.
According to Charles Ray Jones, in most gestational Lyme borreliosis cases the disease is already detectable at birth, or not long after that. During his researsh, he found the following frequency of symptoms:
| Percentage: | Symptoms: |
| 80 | Irritability |
| 80 | Cognitive problems, learning disabilities and mood swings |
| 72 | Fatigue and lack of stamina |
| 60 | Low grade fevers, pallor, and dark circles under their 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 | Noise, light and skin sensitivity |
| 30 | Eye problems: posterior cataracts, myopia, astigmatism, conjunctival erythema (Lyme eyes), optic nerve atrophy and optic neuritis and/or uveitis |
| 30 | Cavernous haemangiomas |
| 23 | Secondary rashes |
| 20 | Abdominal pain |
| 18 | Developmental delay, including language, speech problems and hypotonia |
Several infectologists who treat children draw attention to development anomalies and neuropsychiatric problems caused by Lyme borreliosis. Although more and more evidence is available to back the theory that Lyme borreliosis can cause mental problems in newborns, there is still some debate on whether Lyme borreliosis – or other tick-borne illnesses – can cause neuropsychiatric symptoms at all.
One piece of this evidence is a retrospective study where 102 pregnant woman with Lyme borreliosis were monitored with regard to neuropsychiatric symptoms and the following data was recorded in the child:
- Hyperactivity, lack of concentration and the diagnosis of ADD (56%)
- Irritability and mood swings (54%)
- Photophobia (43%)
- Poor memory (39%)
- Hyperacuity (36%)
- Cognitive disorders (27%)
- Other sensory sensitivity (23%)
- Anger or rage (21%)
- Speech delay (21%)
- Anxiety (21%)
- Reading/writing disorders (19%)
- Developmental delays (18%)
- Articulation disorders (17%)
- Tic disorders (14%)
- Depression (13%)
- Emotional instability (13%)
- Auditory/visual processing problems (13%)
- Word selectivity problems (12%)
- OCD—11%
- Seizure disorder (11%)
- Involuntary athetoid movements (9%)
- Autism (9%)
- Dyslexia (8%)
- Suicidal thoughts (7%)
In the control group, 66 women with Lyme borreliosis were monitored while they got antibiotic treatment before and during pregnancy: all of them gave birth to healthy infants. However, there were 8 pregnancies in the control group, where Borrelia burgdorferi and/or Bartonella henselae were detectable in the placenta and the umbilical cord.
Conclusions
Based on the observations and research results, we recommend all the women who plan to get pregnant to get tested for Lyme disease – if medical history includes Lyme borreliosis or tick bite -, and if tested positive, antibiotic treatment is also recommended from the second trimester. Currently several antibiotics are available for pregnant women, so the consequences of vertical transmission of Lyme borreliosis can be prevented without any risk of side effects from the medication.
References
- Case Report: Lyme Borreliosis and Pregnancy – Our Experience, Trevisan et al., Front. Med., 2022.
- A systematic review on the impact of gestational Lyme disease in humans on the fetus and newborn, Waddell et al., PLoS One. 2018
- Lyme disease during pregnancy, Silver, Infect Dis Clin North Am. 1997
- Gestational Lyme borreliosis. Implications for the fetus, MacDonald, Rheum Dis Clin North Am. 1989
- Gestational Lyme Disease Case Studies of 102 Live Births, Jones et al., Gestational Lyme Studies, Lyme Times, 2014
- Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice, Bransfield, Healthcare (Basel). 2018
