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. 2025 Mar 14;57(1):119–130. doi: 10.3947/ic.2024.0120

Unveiling the Outcomes of Mpox in Pregnancy: A Systematic Review and Single-Arm Meta-Analysis

I Gde Sastra Winata 1,✉, Leonardo Leonardo 1,2, Rosalia Sylfiasari 2, Angeline Ekafentie 3, Surya Sinaga Immanuel 2, Fenyta Christyani 1
PMCID: PMC11972915  PMID: 40183658

Abstract

Background

The global resurgence of mpox, formerly monkeypox, poses an emerging threat to pregnant women due to immunological changes and potential vertical transmission, yet its impact on pregnancy remains underexplored. This study aims to pioneer a comprehensive assessment of pregnancy outcomes and the risks of vertical transmission associated with mpox infection during pregnancy.

Materials and Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched three databases up to September 2024 for studies on pregnant women with mpox confirmed by quantitative polymerase chain reaction. Primary outcomes were composite adverse pregnancy outcomes: miscarriage or fetal death, congenital anomalies, and chorioamnionitis; the secondary outcome was vertical transmission. Study quality was assessed using Joanna Briggs Institute tools. Statistical analysis employed R software using a one-proportion model with Freeman-Tukey transformation and random-effects meta-analysis (restricted maximum-likelihood estimator, Knapp-Hartung adjustment), presenting estimated proportions with 95% confidence intervals (CIs).

Results

Six studies (three case series, three case reports) comprising 11 singleton pregnancies were included. Diagnoses occurred in the first (27.3%), second (45.4%), and third trimesters (27.3%). Among the five genotypically identified Mpox cases, 20.0% were classified Clade I and 80.0% as Clade II. Meta-analysis indicated that an estimated 63% (95% CI, 43–83%) of pregnancies experienced composite adverse pregnancy outcomes. Specifically, miscarriage or fetal death occurred in 62% (95% CI, 21–102%), congenital anomalies in 50% (95% CI, 21–80%), and chorioamnionitis in 78% (95% CI, 44–96%). Vertical transmission was observed in 79% (95% CI, 6–151%). Despite small sample sizes leading to wide confidence intervals, high estimated proportions suggest that mpox severely impacts pregnancy outcomes, likely linked to maternal inflammation, placental invasion, and significant fetal risks from vertical transmission.

Conclusion

Mpox infection during pregnancy appears to be associated with high rates of adverse pregnancy outcomes and vertical transmission. Further large-scale studies are warranted to confirm these findings and develop preventive and management strategies mitigating this emerging threat.

Keywords: Monkeypox virus, Mpox, Pregnancy, Vertical transmission

Graphical Abstract

graphic file with name ic-57-119-abf001.jpg

Introduction

Mpox, formerly known as monkeypox, is a zoonotic viral infection caused by the monkeypox virus (MPXV), a member of the Orthopoxvirus genus. Historically endemic to central and west Africa, mpox has recently emerged as a global public health concern following outbreaks in non-endemic regions [1]. The increasing incidence of mpox raises significant concerns for vulnerable populations, particularly pregnant individuals. Similar to those with Toxoplasma gondii, other agents, Rubella virus, Cytomegalovirus, and Herpes simplex virus (TORCH) infections, mpox poses potential risks of vertical transmission, along with serious implications for both maternal and fetal health [2,3].

Previous studies on Orthopoxviruses, including Variola virus (the causative agent of smallpox), have shown that viral infections during pregnancy can increase the risk of severe complications, such as spontaneous abortion, preterm birth, and neonatal infections [4,5]. Given the similar nature of mpox and smallpox, it is critical to examine whether mpox poses a comparable threat to pregnant individuals. Although studies have been conducted in the general population, limited and inconsistent data on mpox outcomes during pregnancy have fueled ongoing debates about the potential risks and clinical management of this infection [6,7].

This systematic review and single-arm meta-analysis aims to pioneer a comprehensive assessment of pregnancy outcomes and the risks of vertical transmission associated with mpox infection during pregnancy. By clarifying the impact of mpox on pregnant individuals, this review intends to contribute to the ongoing discourse and enhance our understanding of the associated risks, ultimately informing future clinical guidelines and public health policies.

Materials and Methods

1. Study design and registration

This systematic review and single-arm meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42024600433).

2. Ethical considerations

As this study was a systematic review and meta-analysis of previously published data, ethical approval and informed consent were not required.

3. Search strategy

A comprehensive literature search was performed in September 2024, across three electronic databases: PubMed, EBSCOhost, and Proquest. The search aimed to identify studies reporting on mpox (monkeypox) infection during pregnancy. The search strategy combined relevant keywords and Medical Subject Headings (MeSH) terms related to mpox and pregnancy, including "mpox", "monkeypox virus", "pregnancy", and "pregnant women". Boolean operators "AND" and "OR" were used to refine the search results. No language restrictions were applied to ensure comprehensive retrieval of relevant studies. Additionally, the reference lists of all included articles and pertinent reviews were manually screened to identify additional eligible studies.

4. Eligibility criteria

Studies were included if they met the following criteria: involved pregnant women diagnosed with mpox infection confirmed by quantitative polymerase chain reaction (qPCR); were primary studies; provided sufficient data to extract outcomes of interest; and reported at least one of the primary outcomes (miscarriage or fetal death, congenital anomalies, chorioamnionitis) or the secondary outcome (vertical transmission). We only confirm the occurrence of vertical transmission if a study explicitly mentions or reports the diagnosis of mpox in infants or fetuses being confirmed through qPCR (e.g., samples taken from the umbilical cord vein, breaking of membranes, or trans-cutaneous amniocentesis). Studies were excluded if they did not involve pregnant women, lacked confirmation of mpox infection by qPCR, did not report specific pregnancy outcomes, or were reviews, editorials, commentaries, or conference abstracts without full data.

5. Study selection

All identified records were imported into EndNote X9 (Clarivate Analytics, Philadelphia, PA, USA), and duplicates were removed using the software's duplicate identification function. Titles and abstracts of all retrieved articles were screened independently to identify studies that met the inclusion criteria or required further evaluation. Full-text articles were obtained for those meeting the criteria or when eligibility was unclear. The full-text articles were then assessed independently for eligibility, and any disagreements were resolved through discussion or consultation with an additional reviewer.

6. Data extraction

Data extraction was conducted independently using a standardized data extraction form. Extracted data included study characteristics (authors, publication year, study design), patient demographics (maternal age, gestational age at diagnosis, MPXV type, maternal viral load, maternal clinical presentation, treatment given, delivery method), pregnancy outcomes (miscarriage or fetal death, congenital anomalies, chorioamnionitis), and vertical transmission status. For studies with multiple reports or overlapping data, the most comprehensive dataset was used. Any discrepancies in data extraction were resolved by consensus or through consultation with an additional reviewer.

7. Quality assessment

The methodological quality of the included studies was assessed independently using the Joanna Briggs Institute (JBI) critical appraisal tools for case reports and case series. The appraisal evaluated aspects such as patient selection, diagnostic methods, outcome measurements, and clarity of reporting. Each criterion was rated as "Yes", "No", "Unclear", or "Not applicable". The quality assessment results informed the interpretation of the findings but did not lead to the exclusion of any studies.

8. Statistical analysis

The primary analysis estimated the pooled incidence of outcomes, expressed as proportions per 100 pregnancies. Given the rarity of mpox infection in pregnancy and the small sample sizes, which included studies with zero or one event, a one-proportion meta-analysis model was employed. The Freeman-Tukey double arcsine transformation was used to stabilize variances, reducing the influence of studies with extreme proportions and providing more reliable pooled estimates for rare events [8].

A random-effects model with the restricted maximum-likelihood estimator was applied to account for potential heterogeneity among studies. The Knapp-Hartung adjustment was utilized to provide more accurate confidence intervals, which is especially important in meta-analyses with a small number of studies and uncertain between-study variance [9].

Statistical heterogeneity was assessed using the I2 statistic and Cochran's Q test. An I2 value greater than 75% was considered indicative of a high degree of heterogeneity [10]. All analyses were performed using the meta package in R (version 4.3.1, R Project for Statistical Computing, Vienna, Austria) [11]. Due to the limited number of studies and small sample sizes, sensitivity analyses and assessments of publication bias were not performed, as these methods are less reliable under such conditions [8].

Results

A total of 174 records were identified through database searches. After removing 69 duplicates, 105 titles and abstracts were screened, leading to the exclusion of 94 irrelevant studies. Eleven full-text articles were assessed for eligibility; five were excluded because three did not confirm the diagnosis with qPCR and two evaluated different outcomes. Ultimately, six studies met the inclusion criteria and were included in the final analysis. The study selection process is illustrated in the PRISMA flow diagram (Fig. 1). Quality assessment using the JBI tools for case reports (Fig. 2) and case series (Fig. 3) indicated that four studies had a low risk of bias, while two had a moderate risk.

Figure 1. PRISMA flow diagram depicting study selection.

Figure 1

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PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; qPCR, quantitative polymerase chain reaction.

Figure 2. Risk of bias assessment using the JBI tools for case reports.

Figure 2

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JBI, Joanna Briggs Institute.

Figure 3. Risk of bias assessment using the JBI tools for case series.

Figure 3

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JBI, Joanna Briggs Institute.

The six included studies comprised three case reports and three case series, encompassing a total of 11 singleton pregnancies. These studies were published between 2017 and 2024. Mpox diagnoses occurred during the first trimester in 27.3% of cases, the second trimester in 45.4%, and the third trimester in 27.3%. The identified MPXV clades were Clade I in 20.0% of cases and Clade II in 80.0%. Detailed baseline characteristics are summarized in Table 1.

Table 1. Characteristic of included studies.

Study Design Maternal age (years) Gestational age at diagnosis (weeks) MPXV type Maternal viral load (genome copies/mL) Maternal clinical presentation Treatment given Delivery method Adverse pregnancy outcomes
Mbala et al. (2017) Case series Case I 20 6 NR 3.5×103 • Fever • Antibiotic (amoxicillin, erythromycin, chloramphenicol) SVE M/FD
Case II 25 6–7 7.9×105 • Vesicular rash • Analgesic (paracetamol, papaverine) SVE M/FD
Case III 29 14 2.3×105 • Enanthems in the oral cavity • Antiparasitic (metronidazole and mebendazole) NR None
Case IV 22 18 8.9×105 D&E M/FD, CA
Contag et al. (2023) Case series Case I 19 24 Clade II NR • Severe pruritus NR NR CH
Case II 23 36 Clade II NR • No symptoms were noted NR NR CH
Renfro et al. (2023) Case series Case I 19 24 Clade II NR • Vaginal pruritus • Antibiotic (ampicillin and gentamicin) SVB CH
• Antiparasitic (metronidazole)
Case II 22 36 Clade II NR • No symptoms were noted • Antibiotic (ampicillin and gentamicin) SVB CH
Sampson et al. (2023) Case report 20 31 NR NR • Labial ulcer • Antiviral (tecovirimat and acyclovir) SVB None
• Papular rash
• Inguinal lymphadenopathy
• Vaginal discharge and bleeding
• Dysuria
Schwartz et al. (2023) Case report 22 19 Clade I 1.0×106 • Fever NR SVB M/FD, CA
• Maculopapular rash
• Submandibula lymphadenopathy
Hernández et al. (2024) Case report 24 4 NR NR • Asthenia • Antiviral (acyclovir) SVB CH
• Burning rash (maculopapular, pustular, umbilicated, and crusting) starting in the genital area, progressing to the perianal region, back, legs, arms, and soles • Antifungal (clotrimazole)
• Inguinal lymphadenopathy • Antibiotic (azithromycin)
Summarya 11b 19–29c Trimester I: 3/11 (27.3%) Clade I: 1/5 (20.0%) 3.5×103–1.0×106d Fever: 5/11 (45.4%) Analgesics: 1/8 (12.5%) SVE: 2/8 (25.0%) M/FD: 4/11 (36.4%)
Trimester II: 5/11 (45.4%) Clade II: 4/5 (80.0%) Rash: 7/11 (63.6%) Antiviral: 2/8 (25%) D&E: 1/8 (12.5%) CA: 2/11 (18.2%)
Trimester III: 3/11 (27.3%) Pruritus: 2/11 (18.2%) Antibiotics: 4/8 (50%) SVB: 5/8 (62.5%) CH: 5/11 (45.5%)
Lymphadenopathy: 3/11 (27.3%) Antifungal: 1/8 (12.5%) CS: 0/8 (0%)
Genitourinary symptoms: 3/11 (27.3%) Antiparasitic: 2/8 (25%)
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aAccounting for only the available or reported data.

bTotal number of pregnant women, all with singleton pregnancies.

cRange of minimal to maximal years of maternal age.

dRange of minimal to maximal genome copies/mL of maternal viral load.

MPXV, Monkeypox virus; NR, not reported; SVE, spontaneous vaginal expulsion; ; M/FD, miscarriage or fetal death; D&E, dilatation & evacuation; CA, congenital anomalies; CH, chorioamnionitis; SVB, spontaneous vaginal birth; CS, caesarean section.

The meta-analysis estimated that approximately 62% (95% confidence interval [CI], 21%–102%) of pregnancies with mpox resulted in miscarriage or fetal death (Fig. 4). Although the upper limit of the CI exceeds 100% due to the small sample size and statistical adjustments, this indicates a high incidence of this adverse outcome among affected pregnancies.

Figure 4. Forest plot: Pooled proportion of miscarriage or fetal death events in pregnant women with mpox.

Figure 4

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An estimated 50% (95% CI, 21%–80%) of pregnancies with mpox were associated with congenital anomalies (Fig. 5).

Figure 5. Forest plot: Pooled proportion of congenital anomalies events in pregnant women with mpox.

Figure 5

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Chorioamnionitis occurred in approximately 78% (95% CI, 44%–96%) of mpox-infected pregnancies (Fig. 6).

Figure 6. Forest plot: Pooled proportion of chorioamnionitis in pregnant women with mpox.

Figure 6

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The composite adverse pregnancy outcomes—defined as the occurrence of miscarriage/fetal death, congenital anomalies, or chorioamnionitis—was estimated at 63% (95% CI, 43%–83%) among pregnancies affected by mpox (Fig. 7).

Figure 7. Forest plot: Pooled proportion of composite adverse pregnancy outcomes in pregnant women with mpox.

Figure 7

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The rate of vertical transmission was estimated to be 79% (95% CI, 6%–151%) (Fig. 8). The wide CI reflects the small sample size and statistical limitations but suggests a high potential for vertical transmission during pregnancy.

Figure 8. Forest plot: Pooled proportion of vertical transmission risk in pregnant women with mpox.

Figure 8

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Despite the limited sample size and wide CIs, the high estimated proportions of adverse outcomes indicate that mpox infection during pregnancy is associated with significant risks, including miscarriage or fetal death, congenital anomalies, chorioamnionitis, and vertical transmission.

Discussion

The findings of this meta-analysis demonstrate a notable risk of adverse pregnancy outcomes and vertical transmission. Compared to the previous meta-analysis of mpox in pregnancy by D’Antonio et al. [12], our study adheres to stricter inclusion criteria and analyzes a larger dataset, thereby contributing a new dimension to the existing knowledge on mpox infection during pregnancy. Additionally, we recognize the importance of examining the characteristics of the included studies to gain a better understanding of mpox in pregnancy.

Of the five cases tested for viral strain in our study, 1 case (20.0%) was identified as Clade I and 4 cases (80.0%) as Clade II. The Clade I case was associated with congenital anomalies and miscarriage, while all Clade II cases resulted in chorioamnionitis. Vertical transmission was confirmed in the Clade I case, whereas the Clade II cases were not assessed for vertical transmission. These findings align with known differences in pathogenicity between the strains. Previous studies on the general population show that Clade I has a case fatality rate of 10–15% in unvaccinated individuals, rising to 15% in children, with established human-to-human transmission. In contrast, Clade II causes milder disease, is less transmissible, and has a lower case fatality rate of 1–6%. Clade I also demonstrates greater virulence in experimentally infected non-human primates compared to Clade II [13,14].

In our study, the maternal viral load is vary from 3.5 × 103–1.0 × 106 genome copies/mL showing a wide spectrum of clinical manifestations ranging from rash, lymphadenopathy, to fever [6,15,16,17,18,19,20]. From the two studies we assessed that reported positive vertical transmission, both studies noted the highest maternal viral loads among those documented. The study by Mbala et al. showed a maternal viral load of 8.9×105 genome copies/mL, ranking as the second highest with positive reports of vertical transmission. The highest maternal viral load among the studies we assessed was reported by Schwartz et al., at 1.0×106 genome copies/mL, aligning with findings from the study conducted by Nachega et al., which demonstrated that monkeypox can be transmitted from mother to fetus, with high viral loads (≥106 copies/mL) detected in maternal–fetal interface tissues [21].

Our assessed studies, such as those by Contag et al. and Renfro et al., demonstrate serological evidence of MPXV infection in asymptomatic individuals. This indicates that some instances of mpox go undiagnosed and require testing [19,20]. Meanwhile, Accordini et al. reported that an asymptomatic patient exhibited a viral load in an anal swab indicating a viable virus, and MPXV was isolated from a urethral swab, suggesting that asymptomatic individuals can transmit the virus through sexual contact [22]. It is also important to note that qPCR samples have varying times required to confirm the presence of the MPVX, depending on the site of sample collection. The timeframes were 14 days for skin lesions, 5 days for oropharyngeal samples, 10 days for rectal samples, 2 days for semen, and immediate for blood [23]. We stress the importance of further investigating the role of unrecognized infections in monkeypox transmission, even through atypical routes [24,25]. As of now, the Royal College of Obstetricians and Gynaecologists does not recommend routine screening of asymptomatic pregnant women. Hence, a thorough history should assess exposure risks, including travel, contact with mpox cases, sexual history, and animal exposure. If needed, a full sexual health screening may be conducted [26].

How MPXV may lead to miscarriage or fetal death is explained in a hypothesis by Dashraath et al., which outlines that the MPXV may ascend from the vagina and cervix to infect cells in the chorionic membranes [27]. It can be transmitted through genital fluids, with the virus found and persisting in the reproductive tract. The other proposed pathway is maternal viremia that might allow the virus to reach the placenta via uterine arteries, infecting the decidua and placental tissues, potentially entering fetal circulation. Placental histology from pregnancies with congenital cowpox and smallpox (Orthopoxviruses) closely related to the monkeypox virus. Thus, the hypothesis regarding cowpox can be used to propose pathways through which monkeypox could be vertically transmitted in utero. Additionally, the virus may directly infect syncytiotrophoblasts due to the inflammation associated with mpox that could enable the virus to access fetal blood, as maternal immune responses may disrupt protective networks around the syncytiotrophoblast.

Our analysis suggests that mpox infection in pregnancy may pose a risk for congenital anomalies. Similar outcomes have been observed with other viral infections, such as Zika virus, which is known for causing congenital anomalies like microcephaly and brain malformations. Additionally, past studies of smallpox in pregnancy, another orthopoxvirus, demonstrated with poor fetal outcomes [28,29]. Although mpox is less severe than smallpox, the risks of adverse pregnancy outcomes, including congenital anomalies, remain concerning. Potential mechanisms for congenital anomalies caused by mpox include direct viral transmission to the fetus via the placenta and maternal immune responses that lead to systemic inflammation and placental damage, which may result in the production of soluble immune factors that could reach the fetus and affect its development [30].

Chorioamnionitis, an inflammation of the fetal membranes (amnion and chorion) often caused by bacterial infections. However, viral infections, including mpox, could trigger or exacerbate this condition. Chorioamnionitis was observed in several cases, suggesting a potential link between mpox infection and the development of this condition, though the underlying mechanisms remain speculative. One potential pathway could involve mpox-induced immune responses that lead to inflammatory reactions in the placenta, as has been observed with other viral infections such as Herpes simplex virus and Cytomegalovirus, which are also known to cause chorioamnionitis [30,31,32]. Moreover, infections such as Zika and coronavirus disease 2019 have shown that viral agents can increase susceptibility to chorioamnionitis due to immune dysregulation and inflammation, a mechanism that may also be relevant in mpox [31].

In our study, antivirals like tecovirimat and acyclovir were given, but no significant adverse pregnancy outcomes related to these medications were observed. According to American College of Obstetrics and Gynecologists, tecovirimat should be considered the first-line antiviral for pregnant, recently pregnant, or breastfeeding individuals if treatment is necessary. There is no human data on tecovirimat's use during pregnancy and lactation, and its effects on reproductive development are based only on animal studies, which did not show specific fetal effects. It is unclear if tecovirimat can prevent congenital mpox. In animal studies, tecovirimat was found in breast milk, but it is unknown if the levels are sufficient to treat a breastfeeding child with mpox. Therefore, breastfeeding children with mpox should be treated separately if needed [32].

Alongside transplacental transmission, the possibility of transmission via the vaginal canal remains a concern, particularly in cases of genital involvement. For mpox-positive mothers showing such symptoms, a cesarean section might be preferred to avoid direct exposure to the fetus during delivery [6]. Although two cases by Sampson et al. and Hernandez et al. reporting genitourinary symptoms showed that none of the babies tested positive for mpox at the time of delivery, these findings only eliminate evidence of vertical transmission via transplacental or in utero routes [15,17]. Transvaginal vertical transmission may still lead to later infection occurrences, following the virus' incubation period. Thus, we underscore the need for careful monitoring and individualized decisions regarding the mode of delivery.

Mpox infection during pregnancy appears to be associated with high rates of adverse pregnancy outcomes and vertical transmission, emphasizing the necessity to consider this infection in prenatal care protocols. In efforts to prevent vertical transmission, there may be a need to expand the TORCH infection panel to include monkeypox, transforming it into M-TORCH. Furthermore, more comprehensive case reporting and larger, well-designed studies are warranted to confirm these findings and develop preventive and management strategies to mitigate this emerging threat.

Footnotes

Funding: None.

Conflict of Interest: No conflict of interest.

Author Contributions:
  • Conceptualization: IGSW, LL.
  • Data curation: LL, RS, AE.
  • Formal analysis: SSI.
  • Investigation: LL, RS, AE, SSI.
  • Methodology: LL, SSI.
  • Project administration: LL, RS, AE, FCY.
  • Supervision: IGSW.
  • Visualization: LL, RS, AE, SSI, FCY.
  • Writing - original draft: IGSW, LL, RS, AE.
  • Writing - review & editing: SSI, FCY.

References

  • 1.Vaughan A, Aarons E, Astbury J, Brooks T, Chand M, Flegg P, Hardman A, Harper N, Jarvis R, Mawdsley S, McGivern M, Morgan D, Morris G, Nixon G, O’Connor C, Palmer R, Phin N, Price DA, Russell K, Said B, Schmid ML, Vivancos R, Walsh A, Welfare W, Wilburn J, Dunning J. Human-to-human transmission of Monkeypox virus, United Kingdom, October 2018. Emerg Infect Dis. 2020;26:782–785. doi: 10.3201/eid2604.191164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Thornhill JP, Palich R, Ghosn J, Walmsley S, Moschese D, Cortes CP, Galliez RM, Garlin AB, Nozza S, Mitja O, Radix AE, Blanco JL, Crabtree-Ramirez B, Thompson M, Wiese L, Schulbin H, Levcovich A, Falcone M, Lucchini A, Sendagorta E, Treutiger CJ, Byrne R, Coyne K, Meyerowitz EA, Grahn AM, Hansen AE, Pourcher V, DellaPiazza M, Lee R, Stoeckle M, Hazra A, Apea V, Rubenstein E, Jones J, Wilkin A, Ganesan A, Henao-Martínez AF, Chow EJ, Titanji BK, Zucker JE, Ogoina D, Orkin CM Share-Net writing group. Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series. Lancet. 2022;400:1953–1965. doi: 10.1016/S0140-6736(22)02187-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Baghel S, Inamdar SA. TORCH infection and its influence on high-risk pregnancy. J South Asian Fed Obstet Gynecol. 2020;12:376–382. [Google Scholar]
  • 4.Khalil A, Samara A, O’Brien P, Morris E, Draycott T, Lees C, Ladhani S. Monkeypox and pregnancy: what do obstetricians need to know? Ultrasound Obstet Gynecol. 2022;60:22–27. doi: 10.1002/uog.24968. [DOI] [PubMed] [Google Scholar]
  • 5.Kang Y, Yu Y, Xu S. Human monkeypox infection threat: A comprehensive overview. PLoS Negl Trop Dis. 2023;17:e0011246. doi: 10.1371/journal.pntd.0011246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Mbala PK, Huggins JW, Riu-Rovira T, Ahuka SM, Mulembakani P, Rimoin AW, Martin JW, Muyembe JT. Maternal and fetal outcomes among pregnant women with human monkeypox infection in the democratic Republic of Congo. J Infect Dis. 2017;216:824–828. doi: 10.1093/infdis/jix260. [DOI] [PubMed] [Google Scholar]
  • 7.Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM NHS England High Consequence Infectious Diseases (Airborne) Network. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022;22:1153–1162. doi: 10.1016/S1473-3099(22)00228-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health. 2013;67:974–978. doi: 10.1136/jech-2013-203104. [DOI] [PubMed] [Google Scholar]
  • 9.Barker TH, Migliavaca CB, Stein C, Colpani V, Falavigna M, Aromataris E, Munn Z. Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence. BMC Med Res Methodol. 2021;21:189. doi: 10.1186/s12874-021-01381-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48. [Google Scholar]
  • 12.D’Antonio F, Pagani G, Buca D, Khalil A. Monkeypox infection in pregnancy: a systematic review and metaanalysis. Am J Obstet Gynecol MFM. 2023;5:100747. doi: 10.1016/j.ajogmf.2022.100747. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Schwartz DA, Ha S, Dashraath P, Baud D, Pittman PR, Waldorf KA. Monkeypox virus in pregnancy, the placenta and newborn: an emerging poxvirus with similarities to smallpox -and:other orthopoxvirus agents causing maternal and fetal disease. Arch Pathol Lab Med. 2023;147:746–757. doi: 10.5858/arpa.2022-0520-SA. [DOI] [PubMed] [Google Scholar]
  • 14.Schwartz DA, Pittman PR. Mpox (Monkeypox) in pregnancy: viral clade differences and their associations with varying obstetrical and fetal outcomes. Viruses. 2023;15:1649. doi: 10.3390/v15081649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.García-Hernández L, Hernández-Aceituno A, Moreno Saavedra RJ, Larumbe-Zabala E. Case report: clinical presentation of Monkeypox in pregnancy. Rev Clin Esp (Barc) 2024;224:245–247. doi: 10.1016/j.rceng.2024.02.009. [DOI] [PubMed] [Google Scholar]
  • 16.Schwartz DA, Mbala-Kingebeni P, Patterson K, Huggins JW, Pittman PR. Congenital Mpox syndrome (Clade I) in stillborn fetus after placental infection and intrauterine transmission, democratic Republic of the Congo, 2008. Emerg Infect Dis. 2023;29:2198–2222. doi: 10.3201/eid2911.230606. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Sampson MM, Magee G, Schrader EA, Dantuluri KL, Bukhari A, Passaretti C, Temming L, Leonard M, Philips JB, Weinrib D. Mpox (Monkeypox) infection during pregnancy. Obstet Gynecol. 2023;141:1007–1010. doi: 10.1097/AOG.0000000000005170. [DOI] [PubMed] [Google Scholar]
  • 18.Oakley LP, Hufstetler K, O’Shea J, Sharpe JD, McArdle C, Neelam V, Roth NM, Olsen EO, Wolf M, Pao LZ, Gold JAW, Davis KM, Perella D, Epstein S, Lash MK, Samson O, Pavlick J, Feldpausch A, Wallace J, Nambiar A, Ngo V, Halai UA, Richardson CW, Fowler T, Taylor BP, Chou J, Brandon L, Devasia R, Ricketts EK, Stockdale C, Roskosky M, Ostadkar R, Vang Y, Galang RR, Perkins K, Taylor M, Choi MJ, Weidle PJ, Dawson P, Ellington S CDC Mpox Analytics Team. Mpox cases among cisgender women and pregnant persons - United States, May 11-November 7, 2022. MMWR Morb Mortal Wkly Rep. 2023;72:9–14. doi: 10.15585/mmwr.mm7201a2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Contag CA, Renfro ZT, Lu J, Shen S, Karan A, Solis D, Huang C, Sahoo MK, Yamamoto F, Jones MS, Lin J, Levy V, Pinsky BA. Prevalence of Mpox (Monkeypox) in patients undergoing STI screening in northern California, April-September 2022. J Clin Virol. 2023;164:105493. doi: 10.1016/j.jcv.2023.105493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Renfro ZT, Contag CA, Lu J, Solis D, Huang C, Sahoo MK, Yamamoto F, Mah J, Jones MS, Lin J, Levy V, Pinsky BA. Two cases of MPXV infection during pregnancy in heterosexual cisgender women without classic cutaneous lesions, Northern California, 2022. IDCases. 2023;33:e01881. doi: 10.1016/j.idcr.2023.e01881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Nachega JB, Mohr EL, Dashraath P, Mbala-Kingebeni P, Anderson JR, Myer L, Gandhi M, Baud D, Mofenson LM, Muyembe-Tamfum JJ Mpox Research Consortium (MpoxReC) Mpox in pregnancy - risks, vertical transmission, prevention, and treatment. N Engl J Med. 2024;391:1267–1270. doi: 10.1056/NEJMp2410045. [DOI] [PubMed] [Google Scholar]
  • 22.Accordini S, Cordioli M, Pomari E, Tacconelli E, Castilletti C. People with asymptomatic or unrecognised infection potentially contribute to monkeypox virus transmission. Lancet Microbe. 2023;4:e209. doi: 10.1016/S2666-5247(22)00379-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Suñer C, Ubals M, Tarín-Vicente EJ, Mendoza A, Alemany A, Hernández-Rodríguez Á, Casañ C, Descalzo V, Ouchi D, Marc A, Rivero À, Coll P, Oller X, Miguel Cabrera J, Vall-Mayans M, Dolores Folgueira M, Ángeles Melendez M, Agud-Dios M, Gil-Cruz E, Paris de Leon A, Ramírez Marinero A, Buhiichyk V, Galván-Casas C, Paredes R, Prat N, Sala Farre MR, Bonet-Simó JM, Farré M, Ortiz-Romero PL, Clotet B, García-Patos V, Casabona J, Guedj J, Cardona PJ, Blanco I, Marks M, Mitjà O Movie Group. Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain. Lancet Infect Dis. 2023;23:445–453. doi: 10.1016/S1473-3099(22)00794-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Satapathy P, Mohanty P, Manna S, Shamim MA, Rao PP, Aggarwal AK, Khubchandani J, Mohanty A, Nowrouzi-Kia B, Chattu VK, Padhi BK, Rodriguez-Morales AJ, Sah R. Potentially asymptomatic infection of Monkeypox virus: a systematic review and meta-analysis. Vaccines (Basel) 2022;10:2083. doi: 10.3390/vaccines10122083. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Pan D, Nazareth J, Sze S, Martin CA, Decker J, Fletcher E, Déirdre Hollingsworth T, Barer MR, Pareek M, Tang JW. Transmission of monkeypox/mpox virus: A narrative review of environmental, viral, host, and population factors in relation to the 2022 international outbreak. J Med Virol. 2023;95:e28534. doi: 10.1002/jmv.28534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Royal College of Obstetricians and Gynaecologists (RCOG) Mpox (monkeypox) in pregnancy. London: RCOG; 2023. [Accessed 6 September 2024]. Available at: https://www.rcog.org.uk/media/mrpktraf/2023-11-mpox-monkeypox-in-pregnancy.pdf. [Google Scholar]
  • 27.Dashraath P, Alves MP, Schwartz DA, Nielsen-Saines K, Baud D. Potential mechanisms of intrauterine transmission of monkeypox virus. Lancet Microbe. 2023;4:e14. doi: 10.1016/S2666-5247(22)00260-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika virus. N Engl J Med. 2016;374:1552–1563. doi: 10.1056/NEJMra1602113. [DOI] [PubMed] [Google Scholar]
  • 29.Brasil P, Pereira JP, Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, Zin AA, Horovitz D, Daltro P, Boechat M, Raja Gabaglia C, Carvalho de Sequeira P, Pilotto JH, Medialdea-Carrera R, Cotrim da Cunha D, Abreu de Carvalho LM, Pone M, Machado Siqueira A, Calvet GA, Rodrigues Baião AE, Neves ES, Nassar de Carvalho PR, Hasue RH, Marschik PB, Einspieler C, Janzen C, Cherry JD, Bispo de Filippis AM, Nielsen-Saines K. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med. 2016;375:2321–2334. doi: 10.1056/NEJMoa1602412. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Racicot K, Mor G. Risks associated with viral infections during pregnancy. J Clin Invest. 2017;127:1591–1599. doi: 10.1172/JCI87490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, Debenham L, Llavall AC, Dixit A, Zhou D, Balaji R, Lee SI, Qiu X, Yuan M, Coomar D, Sheikh J, Lawson H, Ansari K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Tiberi S, Brizuela V, Broutet N, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Zamora J, Thangaratinam S for PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320. doi: 10.1136/bmj.m3320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.American College of Obstetricians and Gynecologists (ACOG) Obstetric care considerations: Mpox. [Accessed 6 September 2024]. Available at: https://www.acog.org/clinical-information/physician-faqs/obstetric-care-considerations-mpox.

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