Monkeypox and Pregnancy FAQ

The CDC reported a case of monkeypox diagnosed in a pregnant person over the weekend. The current outbreak of monkeypox appears to be driven by the west African clade of the virus, which has historically been considered milder than the central African clade. However, little is known about pregnancy outcomes with the current strain.

What are the symptoms of monkeypox?

Although community transmission has been predominantly among gay or bisexual men during this outbreak, clinicians treating pregnant women should be vigilant for new rashes given that the virus has been detected in seminal fluid and has been transmitted via sexual contact in most cases to date.

Often, the first monkeypox symptoms to appear are a fever and swollen lymph nodes in the throat (tonsils), under the arms and in the groin, but a rash can appear first. Other common viral symptoms may also appear, such as fatigue, headache and muscle aches. Of the 528 infections profiled in a recent New England Journal of Medicine report from 16 countries, 64% of patients had fewer than 10 lesions and about 10% had only 1 lesion. In 75% of cases, the rash appeared in the genital or perianal region but 40% had lesions in the mouth or on the hands. The lesions can be painful or itchy, look like syphilis or varicella (chickenpox), and go through a series of phases, from raised areas which look like pimples or blisters which will eventually scab before healing.

What impact will monkeypox have on my pregnancy?

Ob-gyns can refer to a clinical management algorithm to manage monkeypox in pregnancy. The first step in the protocol is to gather the woman’s exposure history and administer a test for monkeypox following a known or suspected exposure. If the woman has no symptoms, she will be advised to isolate at home for 21 days and self-monitor for fever and rash, then follow up monthly with her clinician to monitor the baby’s growth. When symptoms are present, the algorithm advises that the woman be hospitalized for monitoring and potential pre-term delivery if high risk.

What effect will monkeypox have on my baby if I am diagnosed with the infection?

The first US case of monkeypox diagnosed during pregnancy was reported over the weekend by the CDC. During an infectious diseases webinar, Dr. John Brooks, chief medical officer in the division of HIV prevention, acknowledged “both mom and baby are doing well.” However, he also noted that infection can occur through placental transfer. Previous research conducted in 2017 in Africa among four women infected with the more virulent central African clade resulted in one healthy delivery, two spontaneous miscarriages, and one stillbirth at 18 weeks’ gestation.

Should pregnant women get vaccinated?

The CDC recommends that vaccination be offered to pregnant or breastfeeding women if they are otherwise candidates for vaccination either before or after exposure to monkeypox. The risks and benefits of vaccination should be discussed with the woman’s doctor and if vaccination is desired, JYNNEOS should be used (not ACAM2000).

Should I plan a pregnancy during the monkeypox outbreak?

Although the World Health Organization declared monkeypox a public health emergency of international concern in July, we know that monkeypox is transmitted via close personal contact, sharing linens and personal items like toothbrushes, and sexual contact. It is important for couples to be alert for symptoms of illness and any new lesions in particular.

Should I proceed breastfeeding if I am diagnosed with monkeypox?

The CDC states that the data on breastfeeding women is insufficient to evaluate the safety of JYNNEOS in breastfeeding women. There is no data on whether JYNNEOS passes through human breastmilk or whether vaccination affects milk supply. Although JYNNEOS is a live attenuated (weakened) vaccine, it cannot replicate and is thus not thought to transmit via breastmilk to the infant. If vaccination is critical, a breastfeeding woman can be vaccinated.

What should I do if I develop symptoms of monkeypox during pregnancy?

If you develop a rash and fever, see your ob-gyn for an exam. Your doctor will consider your exposure history and factor in the possibility of the symptoms being caused by another sexually transmitted infection or lesions associated with pregnancy (such as pruritic urticarial papules and plaques of pregnancy).

After more than two years of cautious living, many people are having trouble shaking the anxiety induced by hearing about another virus. As alarming as a new rash illness might be, most people recover in a few weeks without treatment, and those who have a very painful throat or anal lesions can be provided supportive care with pain medication. Antivirals are also available, and vaccination within 4 days of exposure may help prevent illness.

Monkeypox is not as contagious as Covid and is not thought to be easily transmitted in a grocery store or through casual conversations. For women thinking about pregnancy or those who are already pregnant, focus on getting and staying as healthy as possible by taking care of your immune system through eating well, exercising, getting enough sleep, hydrating, and practicing yoga or meditation to manage anxiety. Remember that the immune system handles exposures every day of your life, even ones it has not seen before, and the antibodies you develop will be passed to the baby through the placenta and breastmilk.


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