Lyme disease and pregnancyA62.9

Borrelia infections during pregnancy are not rare. A risk for the fetus when the mother's infection has occurred (e.g. erythema chronicum migrans) has been considered as given by some alarming reports of fetal malformations or premature and stillbirths in connection with maternal infection.

In several larger epidemiological studies, no increased risk for malformations, prematurity, and fetal death could be proven. Waddell LA et al (2018) reported the results of 17 epidemiological studies in a systematic review. The prevalence of adverse birth outcomes in an exposed population (defined as: pregnancy Lyme disease, history of Lyme disease, tick bites or stay in an endemic area) was compared in 8 studies with prevalences in a non-exposed population. The comparison showed no difference.

Other risk factors investigated, such as: time of exposure, duration of Borrelia infection during pregnancy, acute/disseminated Lyme disease at diagnosis and symptomatic Borrelia infection/seropositive women without signs of Borrelia infection during pregnancy were not associated with unfavourable birth outcomes.

However, spirochetes can be transmitted diaplacentally. In this respect a Borrelia infection of the mother should always be treated (Ambros-Rudolph C 2018).

The drug of choice is amoxicillin. Alternative: Cefuroxime Axetil

In case of suspected allergy to ß-lactam antibiotics, azitromycin (FDA pregnancy category B) is recommended.

Doxycycline is the 2nd choice. Doxycycline is contraindicated after the 15th week of pregnancy.

1. Ambros-Rudolph C (2018) Pregnancy dermatoses. In: G. Plewig et al. (ed.), Braun-Falco`s Dermatology, Venerology and Allergology, Springer Reference Medicine. S. 1532
2. Conforti C et al (2019) Overview on the treatment of Lyme disease in pregnancy. G Ital Dermatol Venereol doi: 10.23736/S0392-0488.19.06396-X.
3. Waddell LA et al (2018) A systematic review on the impact of gestational Lyme disease in humans on the fetus and newborn. PLoS One 13:e0207067.