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Pregnant women face a heightened risk of severe mpox due to the immunological and hormonal shifts inherent in pregnancy.1,2 Current evidence indicates that monkeypox virus (MPXV) clade I is linked to more severe clinical outcomes and a greater likelihood of vertical transmission – from mother to fetus – compared to clade II.3
The first documented probable case of MPXV clade I infection during pregnancy occurred in the Democratic Republic of Congo in 1988. A 44-year-old woman experienced preterm labor, delivering a female neonate exhibiting widespread skin rashes indicative of mpox around seven months into her pregnancy.
Mpox, formerly known as monkeypox, is a viral infection that can cause a range of symptoms, including fever, headache, muscle aches, swollen lymph nodes, and a characteristic rash.4 While historically rare, the 2022 global outbreak brought increased attention to the virus and its potential complications, notably for vulnerable populations like pregnant individuals.
The physiological changes of pregnancy suppress the immune system, making pregnant women more susceptible to severe illness from infections like mpox.1 Hormonal fluctuations also play a role in altering immune responses. Furthermore, the placenta does not provide a complete barrier against MPXV, allowing for potential vertical transmission.5
Clade I of MPXV, originating from the Congo Basin, has demonstrated a higher case fatality rate and more severe disease presentation compared to Clade IIb, which was responsible for the majority of cases in the 2022 outbreak.6 This distinction is crucial, as Clade I poses a greater threat to both the mother and the developing fetus.
While data on mpox in pregnancy remains limited, available case reports and studies suggest potential adverse outcomes including miscarriage, stillbirth, and congenital mpox – infection present at birth.7 Early diagnosis and appropriate management are critical to minimizing these risks.
Healthcare providers are advised to consider mpox in pregnant women presenting with compatible symptoms, particularly those with known exposure. Vaccination against mpox is recommended for individuals at high risk, including those who are pregnant or planning to become pregnant.8 The JYNNEOS vaccine is generally considered safe during pregnancy, even though data is still being collected.9
Ongoing research is essential to better understand the impact of mpox on pregnancy and to develop effective strategies for prevention and treatment. Public health officials continue to monitor the situation and provide updated guidance to healthcare professionals and the public.
- World Health Association. (2022). Mpox (monkeypox).https://www.who.int/news-room/fact-sheets/detail/monkeypox
- Centers for Disease Control and Prevention.(2023). mpox and Pregnancy. https://www.cdc.gov/mpox/pregnancy/index.html
- Likeng, A. et al. (2023). monkeypox in pregnancy: a systematic review and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 130(2), 179–188. https://doi.org/10.1111/bjog.15731
- Mayo clinic. (2023). Monkeypox. https://www.mayoclinic.org/diseases-conditions/monkeypox/symptoms-causes/syc-20473613
- European Center for Disease Prevention and Control. (2022). Monkeypox in pregnant women – initial risk assessment. https://www.ecdc.europa.eu/en/publications-data/monkeypox-pregnant-women-initial-risk-assessment
- Friend, S. M., et al. (2023). Global epidemiology of monkeypox: a systematic review and meta-analysis. The Lancet Infectious Diseases, 23(2
