Mpox in Pregnancy: Understanding the Risks and Limited Data
Outbreaks of mpox (formerly known as monkeypox) have raised global health concerns, with a particularly significant impact in the Democratic Republic of Congo (DR Congo).In DR Congo, mpox clade 1 is endemic, meaning it’s consistently present in the population. While mpox affects individuals of all ages and genders, pregnant individuals face unique vulnerabilities. Despite a recognized risk of vertical transmission – the passage of the virus from mother to fetus – comprehensive data regarding the effects of mpox clade I during pregnancy remain scarce, largely limited to small case series and observational studies.
What is Mpox and Why is Clade I Significant?
Mpox is a viral zoonosis – a disease that spreads from animals to humans – caused by the mpox virus,part of the orthopoxvirus family. Symptoms typically begin with fever, headache, muscle aches, backache, and swollen lymph nodes, followed by a rash that can look like pimples or blisters.The illness usually lasts for two to four weeks.
Currently, there are two main clades of the mpox virus: Clade I and Clade II. Clade I, predominantly found in Central Africa, including DR Congo, is associated with more severe disease and a higher fatality rate compared to Clade II, which was responsible for the 2022 global outbreak . This difference in severity is a critical factor when considering the risks to pregnant individuals and their developing fetuses.
The Risk of Vertical Transmission
Vertical transmission of mpox refers to the spread of the virus from a pregnant person to their fetus. This can occur in utero (during pregnancy), during childbirth, or promptly after birth through close contact. The mechanisms of vertical transmission are not fully understood, but placental involvement and direct contact with lesions during delivery are suspected routes.
Evidence of vertical transmission comes from case reports and limited studies. A study published in the Lancet Global Health documented a case of a newborn contracting mpox shortly after birth, confirming the possibility of transmission. The consequences of vertical transmission can be severe, possibly leading to fetal loss, stillbirth, or congenital mpox – mpox infection in the newborn.
Limited Data and Challenges in Research
The lack of robust data on mpox in pregnancy presents a significant challenge for healthcare providers and public health officials. Several factors contribute to this data gap:
- Underreporting: Mpox cases, particularly in resource-limited settings like DR Congo, may go unreported due to limited access to healthcare and diagnostic facilities.
- Small Sample Sizes: Existing studies are often limited to small case series, making it challenging to draw definitive conclusions.
- Ethical Considerations: Conducting research on pregnant individuals requires careful ethical consideration to protect both the mother and the fetus.
- Geographic Concentration: The majority of data on Clade I mpox in pregnancy originates from Central Africa, limiting the generalizability of findings to other regions.
Potential Effects on Pregnancy and the Fetus
while definitive data are lacking, the potential effects of mpox infection during pregnancy are concerning. These may include:
- Miscarriage or Stillbirth: The inflammatory response triggered by mpox infection could potentially lead to pregnancy loss.
- Preterm labour and Delivery: Mpox infection may increase the risk of premature birth.
- Fetal Malformations: Viral infections during pregnancy can sometimes cause birth defects,even though the risk with mpox is currently unknown.
- Neonatal Mpox: As mentioned earlier, newborns can contract mpox from their mothers, leading to a potentially severe illness.
Management and Prevention
Given the potential risks, pregnant individuals in areas where mpox is endemic or experiencing outbreaks should take precautions to minimize their risk of exposure:
- Vaccination: The JYNNEOS vaccine is approved for prevention of mpox and may be considered for pregnant individuals at high risk of exposure, after a discussion with their healthcare provider about the potential benefits and risks.
- Avoid Contact: Avoid close contact with individuals who have suspected or confirmed mpox infection, as well as with animals that may carry the virus.
- Practise Good Hygiene: frequent handwashing with soap and water, and avoiding sharing personal items, can definitely help prevent the spread of the virus.
- Safe Sex Practices: Mpox can be transmitted through sexual contact, so practicing safe sex is crucial.
For pregnant individuals who suspect they have mpox, prompt medical attention is essential. Management focuses on supportive care, including managing symptoms and preventing secondary infections. Close monitoring of the pregnancy is also crucial.
Future Research Needs
addressing the data gap regarding mpox in pregnancy requires urgent research efforts. Key areas for inquiry include:
- Large-Scale Studies: Conducting larger, well-designed studies to assess the incidence of mpox in pregnancy and its associated outcomes.
- Mechanism of Transmission: Investigating the precise mechanisms of vertical transmission to identify potential interventions.
- Vaccine Efficacy: Evaluating the safety and efficacy of mpox vaccination during pregnancy.
- Long-Term Follow-up: Following up on children born to mothers infected with mpox to assess any long-term health effects.
Increased research and surveillance are crucial to better understand the risks of mpox during pregnancy and to develop effective strategies to protect both mothers and their babies. The situation in DR Congo, where clade I mpox is endemic, highlights the urgent need for targeted interventions and improved healthcare access in affected regions.