Pregnant people may face unique risks from monkeypox. A 2022 clinical review lays out what to know—and how maternity teams can respond.
A peer‑reviewed overview published in the American Journal of Obstetrics & Gynecology warns that, during the 2022 global outbreak, monkeypox spread widely through close physical contact and was declared a Public Health Emergency of International Concern. The authors note that infections were confirmed across 95 non‑endemic countries and argue that pregnancy deserves special attention.
Why pregnancy may carry higher risk
Normal immune shifts in pregnancy can blunt some antiviral defenses, and lab studies suggest the virus can evade key interferon pathways. That combination, the authors argue, could increase both susceptibility and the chance of more serious illness. They also outline biologic routes by which the virus could cross the placenta, raising the risk of “vertical” transmission to the fetus. Although data remain limited, reported outcomes after maternal infection include miscarriage, stillbirth, preterm birth, and congenital infection.
Symptoms and how it’s confirmed
In the 2022 outbreak, the PCR tests most likely to turn positive were swabs taken directly from skin or anogenital lesions. Oropharyngeal (throat) swabs can also help early in illness, but blood PCR is less reliable because viremia is brief. Because rashes can mimic other infections in pregnancy, clinicians should also rule out herpes, varicella‑zoster, and syphilis.
Monitoring the fetus
For pregnant patients with confirmed infection—or those with high‑risk exposure and a positive throat PCR—the authors recommend serial ultrasound checks. Possible signs of congenital infection may include hepatomegaly, ascites, hydrops, placental calcifications, and growth restriction. Amniocentesis with RT‑PCR may help confirm fetal infection, though its sensitivity is unknown.
Delivery and immediate newborn care
A delivery protocol is proposed: cesarean birth is preferred if there are active vaginal or rectal lesions or positive lesion PCRs; a negative‑pressure operating room, full PPE, and specific anesthesia and surgical precautions are advised. After birth, breastfeeding and skin‑to‑skin care are delayed until the mother is no longer infectious. If a vaginal birth occurs before testing or de‑isolation, the newborn is considered at higher risk; recommended steps include swabs (skin, throat, rectum) and, in selected cases, consultation about vaccinia immune globulin.
Treatments and vaccines in pregnancy
For severe disease, the review notes tecovirimat as the first‑line antiviral recommended by U.S. authorities; animal data have not shown fetal toxicity, and vaccinia immune globulin (VIGIV) is considered likely safe in pregnancy based on long experience with immunoglobulins. The authors caution that obstetric teams should watch for medication‑related issues such as QT‑interval prolongation, glucose‑monitoring inaccuracies, and risk of blood clots.
For prevention after exposure, the non‑replicating MVA‑BN (Jynneos/Imvanex) vaccine is the preferred option in pregnancy; about 300 pregnancy exposures had been reported without a safety signal. In contrast, the older live‑virus ACAM2000 vaccine carries a risk of fetal vaccinia and is generally avoided in pregnancy.
What we still don’t know
The review calls for urgent studies to pin down the true risk of congenital infection, how often transmission occurs during breastfeeding, and the real‑world safety and effectiveness of antivirals and vaccines in pregnancy.
For expectant parents: practical takeaways
- Know the common signs. An unexplained rash (especially anogenital), fever, swollen lymph nodes, headache, or muscle aches—after close contact or recent travel—warrants medical advice. Testing relies on PCR from lesions; don’t self‑swab at home.
- Limit exposure. Avoid direct contact with rashes and shared items (towels, bedding); discuss safer‑sex practices with partners.
- Ask about vaccination after exposure. Public‑health teams may recommend MVA‑BN for certain pregnant contacts; ACAM2000 is typically not used in pregnancy.
- If infected, stay connected to care. Your team may arrange ultrasound monitoring and will guide delivery planning and newborn precautions.
This article summarizes a 2022 clinical review to help readers understand evolving evidence. Local guidance may change as new data emerge; pregnant individuals should seek personalized advice from their care team.
Source: Dashraath, P., Nielsen-Saines, K., Rimoin, A., Mattar, C. N. Z., Panchaud, A., & Baud, D. (2022). Monkeypox in pregnancy: virology, clinical presentation, and obstetric management. American journal of obstetrics and gynecology, 227(6), 849–861.e7. https://doi.org/10.1016/j.ajog.2022.08.017
Editor’s note: This article is for information only and is not a substitute for professional medical advice.