Perinatal transmission of Borrelia burgdorferi: advancing scientific and clinical understanding of Lyme disease in pregnancy.

Perinatal transmission of Borrelia burgdorferi sensu lato (Bb), the spirochetal agent of Lyme disease, is an issue of public health importance and research significance. This alternate mode of transmission and the potential risk of adverse pregnancy outcomes were communicated within public health spheres following the first suspected case in 1985. Subsequent studies in reservoir and non-reservoir animal hosts, in addition to case reports of perinatal morbidity and mortality in humans brought further attention to the field. Decades later, however, the incidence and epidemiologic impact of perinatal transmission of Bb, as well as the clinical spectrum and potential long-term health sequelae of gestationally exposed children, remain understudied and poorly defined. In June 2022, a Banbury Conference on Perinatal Transmission of Lyme disease was convened at Cold Spring Harbor Laboratory in New York. This manuscript conveys conference findings and research recommendations to advance scientific and clinical understanding of this important issue.