How To Protect Yourself (& Your Baby) From Lyme Disease During Pregnancy
With all the recent news about Lyme disease being on the rise and tick populations exploding, it's natural to feel a bit panicked about getting bitten—especially if you're pregnant and trying to protect two people from any and all health threats. So, as an OB/GYN and Lyme disease expert, it's my goal to arm you with the right information so you can breathe a little easier and take the necessary precautions to keep yourself (and your baby) safe.
What we know about pregnancy and Lyme disease.
If you find yourself experiencing some of this tick terror, first let me offer a little solace: Not all ticks carry the bacteria that cause Lyme disease, so getting bitten does not guarantee a Lyme diagnosis. What's more, even if you do get Lyme disease while you are pregnant, the chances of transmission through the placenta to your unborn child are relatively low.
A study published in 2018 in the journal PLoS One reviewed all published scientific studies over the past 30 years concerning Lyme disease in pregnancy. The conclusion was that while transmission through the placenta can occur, the risk is relatively low, and outcomes of fetuses being affected were also low. For mothers who were healthy or got antibiotics for acute symptoms of Lyme disease, the risk was even lower.
That said, it's important to know that all ticks do carry microbes that can potentially cause illness. Which ones you're exposed to depends in large part on where you are when you get bitten. Borrelia burgdorferi, the microbe most commonly associated with Lyme disease, is predominantly carried by deer ticks (black-legged ticks) that are mostly concentrated around the Northeast and Great Lakes states, but Lyme has been reported in every state, including Alaska and Hawaii.
There are also other species of Borrelia that cause Lyme disease that are transmitted by other tick species, and other tick-borne microbes that can cause illness. For instance, there are many species of Rickettsia, including Rickettsia rickettsii—the microbe that causes Rocky Mountain spotted fever—which is most commonly found in the southeastern part of the United States.
What it boils down to is this: While you shouldn't panic about ticks, you shouldn't let your guard down either—every bite should be considered suspicious. And one of the best ways to shore up your defenses against Lyme and other tick-borne illnesses is to ensure your immune system is healthy and strong.
How to safely boost your immune system during pregnancy to fend off microbes.
Ticks have been biting humans since there were humans, and because of that, our immune systems are very familiar with the microbes they carry. If your immune system is healthy, it will protect you against most microbes that ticks transmit.
On the other hand, a weakened immune system increases the chances of harm to your pregnancy and the likelihood of becoming ill after a tick bite. The reason: Impaired immune function allows your microbiome to shift out of balance and for pathogens in your body to flourish. That includes microbes like Lyme-causing Borrelia, along with any other questionable suspects that may have been lying dormant in your tissues.
Here are the five healthy habits I've found to be the most powerful in strengthening and protecting the immune system so it's better able to manage microbes of all varieties. I consider them especially important for pregnant women, but they can be extremely beneficial for just about anyone:
1. Nourish your body with whole, unprocessed foods.
A healthy diet for immune system support should focus on whole foods, ample vegetables (fill at least 50% of your plate with veggies), and healthy fats. Keep processed foods, grain-fed meats, excess carbohydrates, and unhealthy fats to a minimum. Excess carbs and refined foods, in particular, can lead to insulin resistance and sustained elevation of insulin levels, which strongly suppresses immune system functions.
2. Purify your environment.
3. Find more calm.
The complexities of modern life cause a certain level of pervasive, low-grade tension. When the body exists in a constant state of alert, all of its systems—especially immune system functions—become overly taxed. Adopt some daily stress reduction and management techniques such as practicing meditation, doing yoga, walking outdoors, or even napping.
4. Get moving.
Most of us have sedentary jobs, and prolonged inactivity (especially sitting in front of a computer) is actually stressful to the body. It's associated with immune dysfunction, decreased blood flow, retention of toxins, and more. Doing gentle, restorative exercise every day (and throughout the day, if possible) helps keep the body moving and counters the modern-day pitfall of being too sedentary.
5. Balance your microbiome.
Common stress factors like poor diet, chronic stress, and exposure to toxins can limit diversity of the microbiome and allow for a shift toward pathogens outweighing the good bugs—which isn't a good thing, as it's estimated that 80% of the immune system lies in the gut. Following the tips above, and adding immune-supporting herbs to your daily routine, can go a long way toward promoting microbiome balance.
Top choices of immune-supporting herbs that are safe during pregnancy include reishi mushroom, cordyceps mushroom, Chinese skullcap, and rehmannia. These herbs fine-tune immune system functions so that the immune system can do its job of controlling any threatening microbes.
Preventing tick bites while pregnant—pass on toxic repellents.
Your best defense against Lyme disease and other tick-borne illnesses is to avoid being bitten, of course. And while many of the tips for preventing tick bites and Lyme disease are the same for everyone, there are a few important precautions for pregnant women. Case in point: insect repellents.
Insect repellent products containing natural essential oils are your safest option for deterring ticks during pregnancy. Plants produce essential oils specifically to ward off insects that work to humans' advantage, too. Common essential oils found in natural insect repellents that are safe to use in pregnancy include rose-geranium, lemongrass, and lavender.
The Centers for Disease Control and Prevention (CDC) advises against using oil of lemon eucalyptus (also known as PMD, its chemical acronym) on children, so the Environmental Working Group suggests you also avoid it during pregnancy. Citronella should also be avoided in the last trimester because it can cause contractions.
Turning to chemical repellents, though the CDC and FDA have cleared products containing 50% DEET and permethrin clothing for use during pregnancy, these are very potent chemicals that should be reserved for high-risk exposure. Instead, the EWG suggests using 20% picaridin, DEET at a 20 to 30% concentration, or IR3535 at a 20% concentration.
A final note to be extra safe: Avoid excessive use of any repellent, be sure to wash your hands after applying them, and take a shower at the end of the day to rinse off any residuals.
What to do if you get a tick bite while pregnant.
The first thing to remember is to not panic. Though all ticks carry microbes, most microbes carried by ticks are no match for your immune system. If your immune system is healthy, you and your baby will be fine.
1. Appropriately remove the tick.
Next, it's important to remove the tick as soon as possible. The longer the tick stays embedded, the greater the chances of microbes being transmitted. And don't depend on the 48-hour rule—the theory that there's no risk of Lyme disease if the tick has been embedded for less than 48 hours has been proved false. Microbes can be transmitted as quickly as a few hours for Lyme disease and possibly faster for other tick-borne microbes.
To remove a tick properly, take a pair of tweezers and grasp the tick as far down on the head as possible and pluck it out with a twisting motion. Try to remove all of the head and mouth parts. Then, wash the area with soap and water.
You could save the tick alive and send it to a lab to determine the tick species and have it tested for microbes. But testing is limited to only certain microbes and isn't always reliable. Most people simply dispose of the tick. The best way to dispose of it is by putting it in alcohol, sealing it in a bag, wrapping it tightly in tape, or simply flushing it down the toilet.
2. Support your immune system, and watch for symptoms.
Finally, be sure you're taking all the necessary steps outlined above—healthy diet, exercise, stress management, herbal therapy—to maintain a healthy immune system so your body is armed to fight off any microbes that entered your system.
Now comes the watch-and-wait game of keeping an eye out for symptoms of acute Lyme disease. The most common ones include:
- Mild fever
- Feeling flu-like
- Achy, stiff joints
- Itching rash
- Facial paralysis (Bell's palsy)
- Bull's-eye rash (these occur in about two-thirds of cases)
More severe symptoms, such as high fever, chills, severe headache, severe muscle aches, nausea and vomiting, and spotted rash starting at the extremities and spreading to the torso can indicate a different tick-borne illness, such as Rocky Mountain spotted fever (RMSF).
If you don't develop symptoms, antibiotics aren't necessary. Taking antibiotics is not without risk. Even short-term use of antibiotics can disrupt your microbiome, which may pose more risk to you and your unborn baby than a nonsymptomatic tick bite.
3. Get appropriate antibiotic treatment.
But if you do develop symptoms, you should take antibiotics. Doxycycline, the standard for nonpregnant adults, is not recommended in pregnancy because of possible adverse effects to the unborn child. Instead, the antibiotic of choice during pregnancy, per the CDC recommendations, is 500 mg of amoxicillin three times daily for 21 days. If you're allergic to penicillin, a safe alternative is 500 mg of Cefuroxime twice daily.
For severe symptoms, which could indicate a more virulent tick-borne illness such as RMSF, treatment with the same antibiotic should be continued for at least 30 days or until symptoms resolve. Note that antibiotics do not eradicate all of the microbes but simply reduce their numbers, which enables the immune system to control the infection.
Testing your blood for microbes is a good idea if you have the option. Knowing what you're dealing with can be reassuring. Be aware, however, that testing isn't always reliable and usually doesn't change your treatment options, so it isn't absolutely essential.
Testing is most important if symptoms are severe or not controlled with antibiotic therapy, or if you develop symptoms of a tick-borne illness but are unaware of a tick bite. It's not uncommon for a bite to go unnoticed, especially if it was from a tiny nymph tick and there's no sign of the classic bull's-eye rash.
4. Seek out help for chronic Lyme.
If your symptoms are persistent or recur even after taking extended antibiotic therapy, that's an indicator that your immune system isn't able to completely control the infection. In this case, Lyme disease can become a chronic illness.
Considering that the modern world has become saturated with stress factors that disrupt immune system functions, it shouldn't be surprising that chronic Lyme disease appears to be on the rise. But because the chronic form of Lyme is not widely recognized by the medical community, little is known about the outcomes of pregnancies associated with chronic Lyme disease. That's why seeking out a doctor who's well-informed about chronic Lyme disease and offers a treatment approach that aligns with your values is beneficial for getting your symptoms under control in a way that's safe for your pregnancy.
What I've learned in my practice is that if you are struggling with symptoms of chronic Lyme and become pregnant, support of immune system functions is absolutely essential. A healthful diet, adequate sleep, clean environment, regular exercise, and herbal therapy are the best ways to support your own recovery and to protect your unborn child.
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