Lyme, breastfeeding and pregnancy 2013

[ms dx]

Hello,

Last year we had our first child. Five months after her birth, I was bit by a tick and contracted Lyme disease though we didn't know it was Lyme til more recently because I was misdiagnosed with MS. As a result, I haven't been treated yet for the Lyme but will be soon. I have several concerns.
Firstly, I have breastfed my daughter this whole time and she is now 14 months old. She clearly would have been exposed by now but she seems healthy and happy. Is there a way to know for sure since testing is so unreliable and inaccurate? Would my milk have provided enough antibodies for her to be safe and develop a natural immunity to the bacteria or could she still catch it?
Secondly, we really would like to have more children but I know it is risky with Lyme. Even with antibiotic treatment at this point, is it enough to keep subsequent kids from contracting it? I've heard that unless you are treated in the first month after contacting Lyme that you can't ever fully get rid of it with antibiotics because it had spread so much at that point and burrowed so many places and just is too resistant. If that is true, is there a way to safely have more kids?
Thirdly, if we have more kids and they or the placenta test positive for spirochetes, is there any information on the quality of life you can expect for a child? What types of risks come with treatment for an infant that contracts Lyme from their mother? Will the child always have Lyme if they test positive or can it be eradicated that early on?
There is no way I would want to put our child through what I've experienced this year. Information, treatment and diagnosis for Lyme in the US seem hard to come by so we just want to have an idea of our options and risks before moving forward.
Thank you in advance for your time and help.

Ms Dx

[cpride]

Dear ms dx,

Lyme disease is a common tick-borne illness caused by the spirochete Borrelia burgdorferi. Areas with deer seem to be the ones affected since the disease is passed to humans through the deer tick. Studies show that women exposed to the disease before or during pregnancy and who are receiving or have completed adequate treatment are not at increased risk of congenital anomalies, fetal death, or prematurity. [1,2] Antibiotics are the primary treatment for the disease and erythromycin is the drug of choice in the pregnant woman. [3] Tetracycline should not be used in pregnancy. The vaccine for lyme disease (LYMErix) is no longer available due to safety concerns and possible side effects. Researchers are currently working on a possible new vaccine. This spirochete is transferred in-utero to the fetus during pregnancy so antibiotic therapy should be instituted promptly. You should talk with your OB physician or maternal/fetal specialist prior to becoming pregnant for further guidance. For breastfeeding, we know that antigenic material from the spirochete is found in human milk, although we do not know if it is infectious. According to the CDC, there are currently no reports of Lyme Disease transmission from breastmilk. The CDC website has some good information about Lyme Disease at the following link: [url]http://www.cdc.gov/lyme/faq[/url] which you may find helpful. If diagnosed postpartum or in a breastfeeding mother, the mother should be treated immediately. Although doxycycline therapy is not definitely contraindicated in breastfeeding mothers, alternates such as amoxicillin, cefuroxime, clarithromycin, or azithromycin should be preferred. Because the spirochete antigen has been found in breast milk, breastfeeding should be withheld until treatment with an appropriate antibiotic is instituted. Once treatment is initiated, breastfeeding may be resumed. You may talk with your pediatrician also about your concerns.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center