Lyme borreliosis in pregnancy and associations with parent and offspring health outcomes: An international cross-sectional survey

Abstract

Background: Lyme disease (LD) is a complex tick-borne pathology caused by Borrelia burgdorferi sensu lato bacteria. Currently, there are limited data regarding the health outcomes of people infected during pregnancy, the potential for perinatal transmission to their fetus, and the long-term effects on these children. Therefore, the primary objective of this survey study was to investigate the impact of LD in pregnancy on both the parent and their offspring.

Methods: A seven-section survey was developed and administered in REDCap. Although recruitment was primarily through LD-focused organizations, participation was open to anyone over the age of 18 who had been pregnant. Participant health/symptoms were compared across those with "Diagnosed LD," "Suspected LD," or "No LD" at any time in their lives. The timing of LD events in the participants' histories (tick bite, diagnosis, treatment start, etc.) were then utilized to classify the participants' pregnancies into one of five groups: "Probable Treated LD," "Probable Untreated LD," "Possible Untreated LD," "No Evidence of LD," and "Unclear."

Results: A total of 691 eligible people participated in the survey, of whom 65% had Diagnosed LD, 6% had Suspected LD, and 29% had No LD ever. Both the Diagnosed LD and Suspected LD groups indicated a high symptom burden (p < 0.01). Unfortunately, direct testing of fetal/newborn tissues for Borrelia burgdorferi only occurred following 3% of pregnancies at risk of transmission; positive/equivocal results were obtained in 14% of these cases. Pregnancies with No Evidence of LD experienced the fewest complications (p < 0.01) and were most likely to result in a live birth (p = 0.01) and limited short- and long-term offspring pathologies (p < 0.01). Within the LD-affected pregnancy groups, obtaining treatment did not decrease complications for the parent themselves but did ameliorate neonatal health status, with reduced rates of rashes, hypotonia, and respiratory distress (all p < 0.01). The impact of parent LD treatment on longer-term child outcomes was less clear.

Conclusion: Overall, this pioneering survey represents significant progress toward understanding the effects of LD on pregnancy and child health. A large prospective study of pregnant people with LD, combining consistent diagnostic testing, exhaustive assessment of fetal/newborn samples, and long-term offspring follow-up, is warranted.

Keywords: Lyme borreliosis; Lyme disease; birth outcomes; child health; pregnancy; survey; symptoms; transmission.

FIGURE 1

Participant groups and pregnancy classifications. Of the 763 individuals who commenced the survey, 691 were eligible to participate (at least 18 years old, had been pregnant at least once, and provided written informed consent). Most participants (n = 446) had been diagnosed with Lyme disease (LD) at some point in their lives, while some suspected they had or have Lyme disease but were never diagnosed (n = 45). The remaining participants (n = 200) had never been diagnosed with or suspected they had LD. Overall, the 691 participants had been pregnant a total of 1,454 times, and a valid date of birth/miscarriage date/due date was provided for 1,154 of these pregnancies (79%), allowing for the classification of the pregnancy based on the Lyme disease status of the participant/parent. Pregnancies were classified as “Probable LD” if the parent was diagnosed with Lyme disease and/or observed an erythema migrans (EM) rash prior to or during the pregnancy (may be “Treated” or “Untreated” prior to or during the pregnancy). “Possible LD” pregnancies were those where the parent experienced a tick bite and/or onset of non-EM Lyme disease symptoms prior to or during the pregnancy (all “Untreated”). If at least two dates were provided for diagnosis, tick bite, EM onset, and other symptom onset, and they were all after the pregnancy, it was classified as a “No Evidence of LD” pregnancy, along with any pregnancy in a healthy control with no noted tick bite at any point or no tick bite prior to or during the pregnancy. Fewer than 5% of pregnancies (n = 51) could not be classified due to missing or conflicting dates (“Unclear” pregnancies). The majority (73%, n = 845) of dated pregnancies resulted in a live birth and the Lyme disease status of the child themselves at the time of parent participation in the survey was noted for 99% (n = 835) of live births.