What to know about Lyme disease and pregnancy

Medically reviewed on May 30, 2023 by Morgan Spicer, Medical Communications Manager. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

---

Table of contents

• What is Lyme disease?
• How does Lyme disease impact pregnancy?
• Pregnancy-safe treatments for Lyme disease
• Preventing Lyme disease during pregnancy
• The takeaways
• Related content

---

There are a lot of misconceptions about the symptoms and long-term effects of Lyme disease. Whether you’ve been diagnosed with Lyme disease in the past or just want to be in the know, here’s your guide to preventing and treating Lyme disease during pregnancy.

What is Lyme disease?

Lyme disease is an infection transmitted to humans through the bite of infected ticks. Lyme disease is the most common vector-borne disease in the United States. [1] If left untreated, the infection has the ability to spread to the joints, nervous system, and heart. [1]

Symptoms of Lyme disease

Lyme disease may cause flu-like symptoms such as fever, fatigue, chills, muscle aches, and swollen lymph nodes. [2] Another symptom of Lyme disease is erythema migrans (EM), a rash that begins at the site of the tick bite a few days to a few weeks after being bitten. [2] EM is seen in approximately 70 to 80 percent of infected people, is often characterized as having a bull’s eye appearance, and may feel warm to the touch. [2] EM is typically not itchy or painful, and the appearance of the rash can vary widely. Facial paralysis and heart palpitations may also be a sign of Lyme disease. [3]

Risk factors and reasons to suspect Lyme disease

Untreated Lyme disease can be dangerous. It’s important to know the risk factors of Lyme disease so that you can protect yourself and seek help quickly if you suspect you’ve been infected.

• Region: If you live or have recently visited an area that has a high number of backlegged ticks, you may be at a higher risk of infection. [4] These areas include the Northeast and mid-Atlantic, North central states, and West Coast.
• Presence of a tick: If you have recently found a tick on your body, you should speak to a healthcare provider right away.
• Habitat: Ticks typically live in wooded, shrubby, or grassy areas and may be active any time the temperature is above freezing. [4] The risk of infection is usually the highest in the spring, summer, and fall.
• Activities: Are you a hunter or gardener? If you or someone in your household spends a lot of time gardening, hiking, hunting, etc. there’s some evidence that your risk of Lyme disease increases. [5-6]
• Symptoms: If you are experiencing any flu-like symptoms or other concerning symptoms, you should see a healthcare provider right away.

How is Lyme disease diagnosed?

Lyme disease is caused by an infection from a bacteria called Borrelia. [7] If someone has been exposed to this bacteria, the body begins to make antibodies to help fight off the infection. One way to know if someone may potentially have Lyme disease is by testing the blood for these antibodies. [7] Generally, blood testing is more accurate the longer someone has been infected, and may not be positive until a few weeks after infection. [3-4] If someone is given treatment soon after being infected, it’s possible that their antibody response may be too low to be detected. [4] Even with a positive Lyme disease blood test, an official diagnosis of Lyme disease requires a clinical evaluation including symptoms, travel history, and any record of exposure to a tick.

How does Lyme disease impact pregnancy?

Untreated Lyme disease during pregnancy may lead to placental infection. It’s uncommon for the infection to pass from mother to fetus, but it is possible. [3] If left untreated, maternal Lyme disease may lead to adverse birth outcomes such as miscarriage, preterm birth, and birth defects. [8-9] Untreated Lyme disease can also spread throughout the body, causing irregular heartbeats, pain, muscle weakness, and more. [3-4]

Fortunately, most research suggests that adequate treatment can limit cases of adverse birth outcomes. [8-9] If you suspect you may have Lyme disease, seeking out prompt treatment is the best way to prevent any complications.

How does Lyme disease impact breastfeeding?

If you have been diagnosed with Lyme disease and are receiving treatment, research suggests that it’s safe to continue breastfeeding. [3] There are no reports at this time of Lyme disease transmission through breast milk, and there are a large number of antibiotics that are considered safe for use while breastfeeding. [3,10] You should discuss with a healthcare provider specifically for their recommendations on your use and dosage of antibiotics while breastfeeding.

Can I get pregnant if I have Lyme disease?

At this time there is little research on the effects of Lyme disease on fertility. We know that up to 20% of patients may experience long-term symptoms that occur post-treatment. [4] Some of these symptoms include chronic pain, fatigue, cognitive impairment, and so on. In the majority of cases, antibiotics will cure Lyme disease and patients will make a full recovery. [4]

Pregnancy-safe treatments for Lyme disease

Catching Lyme disease early is one of the best ways to avoid any complications. Lyme disease has the potential to spread very quickly and may result in chronic or damaging symptoms if it’s not treated early. [3-4] In the beginning stages of Lyme disease, treatment typically results in a fast and complete recovery. Treatment for pregnant people is very similar to the treatment given to non-pregnant adults and involves a course of oral antibiotics for two to three weeks. [7] During pregnancy, amoxicillin or cefuroxime axetil are typically the antibiotics of choice. [7] The antibiotic given to the general adult population is called doxycycline and is usually avoided during pregnancy as it may cause fetal harm. [3,7]

In some cases, Lyme disease can lead to long-term health effects such as severe fatigue, neurological problems, mood disorders, and more. [4] There may be additional treatments available to help manage these conditions. If you have specific questions about Lyme disease treatment, speak to your healthcare provider.

Preventing Lyme disease during pregnancy

There are some things you can do to protect yourself and decrease your risk of getting Lyme disease while supporting a healthy pregnancy.

Insect repellant

When spending time outdoors, the CDC recommends using EPA-registered insect repellents that contain ingredients such as DEET, picaridin, IR3535, lemon eucalyptus oil, para-menthane-diol, or 2-undecanone. [3] Research suggests that the benefits of using insect repellents while pregnant outweigh any possible risks. [11] Most data shows that the use of insect repellant is unlikely to cause any harm to fertility or pregnancy. If you are still concerned about the use of repellants while pregnant, some researchers suggest opting for the lowest concentration that can still protect you, or applying the repellant to clothing instead of the skin. [11]

Minimize exposed skin and dry your clothing

Wearing long sleeves, closed shoes, and pants is another way to help prevent tick bites and Lyme disease during pregnancy. Avoid tall brush, leaves, and vegetation when outdoors. It’s also recommended that you tumble clothes in a dryer on high heat for at least 10 minutes to kill any ticks stuck to clothing. [3]

Shower quickly and check for ticks

Showering as soon as you can after spending time outdoors may help decrease the risk of tick bites. You should also check for ticks regularly after spending time outside. Potential areas that ticks may hide include the armpits, behind the knees, in the hair, and near the groin. [4]

Remove ticks carefully

If you do notice any ticks on your skin, remove them immediately and carefully. It can take up to 48 hours for an attached tick to cause an infection. [12] You should use tweezers to pinch the head of the tick and steadily pull upward. Clean the area with soap and water and properly neutralize the tick by putting it in alcohol, placing it in a sealed bag, or wrapping it in tape. Saving the tick by one of these methods can assist with diagnosis if you find yourself having symptoms later, as the healthcare provider will be able to identify the species, as well as test for any specific pathogens. [13] You should speak to a healthcare provider if you do find a tick on you, as they may suggest preventive antibiotics.

The takeaways

Lyme disease can lead to serious complications if not treated, but is generally easy to treat and curable. Symptoms of Lyme disease include fever, chills, a rash, fatigue, muscle aches, and swollen lymph nodes. Lyme disease can be detected by measuring antibodies in the blood and is easily treated using antibiotics. Research suggests that when treated, Lyme disease is unlikely to cause any harm to the pregnancy. Lyme disease can not be transmitted through breast milk. There are pregnancy-safe options for preventing and treating Lyme disease. Everlywell offers an at-home Lyme Disease Test if you want to check for indicators of a Lyme infection.

Related content

Where is Lyme disease common?

Stages of Lyme disease explained

Is Lyme disease contagious?

---

References

1. Lyme Disease. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). January 19 2022. URL.
2. Signs and Symptoms of Untreated Lyme Disease. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). January 15 2021. URL.
3. Pregnancy and Lyme disease. CDC Fact Sheet. URL. Accessed May 2023.
4. Lyme Disease Frequently Asked Questions (FAQ). Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). June 13 2022. URL.
5. Smith G, Wileyto EP, Hopkins RB, Cherry BR, Maher JP. Risk factors for lyme disease in Chester County, Pennsylvania. Public Health Rep. 2001;116 Suppl 1(Suppl 1):146-156. doi:10.1093/phr/116.S1.146
6. Richards, S., Langley, R., Apperson, C., & Watson, E. (2017). Do Tick Attachment Times Vary between Different Tick-Pathogen Systems? Environments, 4(2), 37. https://doi.org/10.3390/environments4020037
7. Skar GL, Simonsen KA. Lyme Disease. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431066/
8. Trevisan G, Ruscio M, di Meo N, Nan K, Cinco M, Trevisini S, Forgione P and Bonin S (2022) Case Report: Lyme Borreliosis and Pregnancy - Our Experience. Front. Med. 9:816868. doi: 10.3389/fmed.2022.816868
9. Strobino BA, Williams CL, Abid S, Chalson R, Spierling P. Lyme disease and pregnancy outcome: a prospective study of two thousand prenatal patients. Am J Obstet Gynecol. 1993;169(2 Pt 1):367-374. doi:10.1016/0002-9378(93)90088-z
10. Bar-Oz B, Bulkowstein M, Benyamini L, et al. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003;26(13):925-935. doi:10.2165/00002018-200326130-00002
11. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. DEET (N,N-ethyl-m-toluamide) 2021 Aug. Available from: https://www.ncbi.nlm.nih.gov/books/NBK582521/
12. Transmission. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). January 20 2023. URL.
13. Tick removal and testing. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). May 13 2022. URL.