Lyme disease is a bacterial infection primarily caused by Borrelia burgdorferi in the United States, and less commonly by Borrelia mayonii. This illness is transmitted to humans through the bite of infected blacklegged ticks, also known as deer ticks (Ixodes scapularis). These ticks acquire the bacteria by feeding on infected wildlife hosts, such as rodents. The infection typically occurs when an infected tick remains attached for more than 24 hours. Lyme disease is most prevalent in forested areas of the northeastern, mid-Atlantic, and north-central United States, as well as in some Pacific Coast regions.
Congenital Lyme Disease
The possibility of being born with Lyme disease, known as congenital Lyme disease, has been a topic of discussion and research. While considered rare, cases of transmission from a pregnant individual to the fetus have been documented. The Centers for Disease Control and Prevention (CDC) acknowledges that untreated Lyme disease during pregnancy can lead to infection of the placenta, and spread from mother to fetus is possible. The official stance from health organizations, including the CDC, indicates that while maternal-fetal transmission is possible, it is extremely rare. Despite this, there is a recognized lack of extensive published studies assessing the developmental outcomes of children whose mothers contracted Lyme disease during pregnancy. Early diagnosis and appropriate antibiotic treatment for the pregnant individual significantly reduce the risk of adverse birth outcomes.
Maternal-Fetal Transmission
Lyme disease can be transmitted from a pregnant individual to the fetus through transplacental transmission, where Borrelia burgdorferi bacteria cross the placental barrier. The spirochetes, the spiral-shaped bacteria causing Lyme disease, have been identified in fetal tissues and placentas in documented cases, similar to other spirochetal infections such as syphilis. Factors influencing this transmission can include the stage of the mother’s infection. While research is limited, some evidence suggests that adverse outcomes are more likely if the mother’s Lyme disease goes untreated during pregnancy. Prompt and appropriate antibiotic treatment of the pregnant individual is considered crucial to prevent the bacteria from infecting the placenta and potentially reaching the fetus.
Recognizing Signs in Newborns
Congenital Lyme disease in infants can manifest with a range of signs, though these are often non-specific and can vary widely, making diagnosis challenging. Some documented outcomes in infants born to mothers with untreated Lyme disease during pregnancy include:
Potential cardiac abnormalities
Respiratory distress
Neurological problems
Developmental delays (including language and speech problems)
Hypotonia (low muscle tone)
Irritability
Gastroesophageal reflux
Frequent infections
The symptoms can be difficult to attribute solely to Lyme disease, as they may mimic other conditions common in newborns. While some studies suggest neuropsychiatric issues like cognitive problems, learning disabilities, and mood swings in children whose mothers had Lyme disease during pregnancy, more comprehensive research is needed to establish definitive links. The severity and presentation of these manifestations can depend on whether the mother received treatment and the timing of the infection during pregnancy.
Diagnosis, Treatment, and Prevention
Diagnosing congenital Lyme disease in infants presents challenges due to the non-specific nature of symptoms and the reliance on maternal history. Standard diagnostic tests for Lyme disease, which typically look for antibodies, may not be accurate in newborns. In some cases, diagnosis may involve examining the mother’s history of Lyme exposure and symptoms, along with specific tests for the infant if clinical suspicion is high. Treatment for affected infants typically involves antibiotics. If the infection has spread to the central nervous system or heart, intravenous antibiotics might be necessary.
Prevention of congenital Lyme disease focuses on avoiding tick bites for pregnant individuals and promptly treating any Lyme infection during pregnancy. Amoxicillin is commonly used and considered safe during pregnancy. Pregnant individuals should take precautions such as using EPA-registered insect repellents, wearing protective clothing in wooded or grassy areas, and performing thorough tick checks after outdoor activities. If a pregnant individual suspects a tick bite or develops symptoms of Lyme disease, seeking early diagnosis and treatment with appropriate antibiotics, such as amoxicillin, is crucial to minimize the risk of maternal-fetal transmission.