As the number of monkeypox infections in the U.S. continues to rise, the first known domestic case in a pregnant woman has been reported, raising concerns among pregnant and breastfeeding patients about the potential for the virus to be passed from an infected mother to a fetus.
In the one reported case, the baby was not infected and both patients are recovering.
The Centers for Disease Control and Prevention (CDC) reports that most cases of monkeypox are mild, although rare severe or fatal infections can occur. Most patients develop initial flu-like illness, followed by blister-like sores or a rash that scabs over and, in most cases, resolves after a few weeks. The virus is transmitted through body fluids and close contact. There is no available data yet to indicate whether the virus can pass to a baby through breastmilk.
The World Health Organization (WHO) declared the monkeypox outbreak a global health emergency on July 23, 2022. Currently, the CDC, WHO, and women’s health organizations such as the American College of Obstetrics and Gynecology (ACOG) and the Society for Maternal-Fetal Medicine are not recommending that pregnant and breastfeeding patients take special precautions compared to nonpregnant people in the U.S.
Though infection risk is low, following common sense steps can help reduce the spread of monkeypox. Understanding how it spreads, how to identify its symptoms, and what to do if you think you’ve been exposed or infected can be beneficial for pregnant and breastfeeding moms.
Related reading: What Texans need to know about monkeypox
How monkeypox spreads
Monkeypox does not spread easily between people who have casual, day-to-day contact such as in the office or the grocery store. It requires close contact with the virus from an infected animal, human, or contaminated object. The current monkeypox outbreak most likely started with travel-related infections but is now being spread person-to-person in more than 40 countries, including the U.S.
According to the CDC, the virus can spread through:
- Respiratory secretions passed during kissing, cuddling, sex, or prolonged face-to-face contact
- Direct contact with an infected person’s body fluids, scabs, rash, or belongings that touched their fluids or lesions
- The placenta of an infected pregnant person to a fetus
Symptoms of monkeypox
Symptoms of flu-like illness, when present, typically appear 4-17 days after exposure to the virus and include:
- Muscle aches
- Swollen lymph nodes
A characteristic rash typically appears a few days later and includes scattered pimples or blisters that are firm and may start small and grow larger. Blisters may become painful or itchy, and eventually scab over.
In pregnant patients, the rash may resemble PUPPP – pruritic urticarial papules and plaques of pregnancy (red, itchy patches on the belly, arms, legs, and rump) or other potentially harmful infections such as syphilis. Talk with your healthcare provider if you notice skin changes or a rash during pregnancy. Most rashes in pregnancy are not monkeypox.
Monkeypox outcomes in pregnancy
Because monkeypox is uncommon, little is known about the potential risks of the infection in pregnant patients, caregivers, and newborns.
Historical reports describe one case of monkeypox infection in a pregnant patient in Zaire in 1983 and four in western Africa in 2017. These cases involved a more severe strain of monkeypox than what is currently circulating. One baby was born healthy, one was born preterm with what may have been monkeypox infection, one was stillborn, and two pregnancies were lost in the first trimester.
While it is not possible to predict risk in pregnancy based on so few cases, we know the virus can be transmitted across the placenta. So, it is important for pregnant patients – and all of us – to do what we can to reduce the risk of exposure.
While the monkeypox virus is not as transmissible as COVID-19, some of the basic hygiene best practices we’ve followed throughout the pandemic, such as practicing physical distancing and washing your hands frequently, can help prevent monkeypox infection.
How to reduce your risk of infection
CDC also recommends the following strategies to further reduce your risk:
- Do not share eating implements, dishes, or cups
- Avoid contact with a sick person’s clothing or bedding
- Refrain from sex if your partner has visible rash or flu-like symptoms
- Use condoms if you or your partner are not monogamous
- Wash your hands often
- Avoid contact with wild animals
- Do not eat or touch products that are made from wild animals
If you don’t feel well, stay home and avoid contact with others. Talk with your Ob/Gyn if you develop a rash. If you have been exposed to the virus, your doctor will work with the infectious diseases team and public health officials to determine whether you need a vaccine or treatment.
Monkeypox vaccination and treatment options
Monkeypox is part of the same family of viruses as smallpox, which was eradicated in the 1980s with the help of vaccines. The U.S. government maintains a stockpile of vaccines against smallpox and monkeypox, and these are provided to individuals at highest risk for infection.
One of these vaccines is ACAM2000, a replicating viral vaccine that includes a live “vaccinia” virus, which is a mild version of the smallpox virus that the body can recognize as it replicates but cannot cause a smallpox infection (similar to the chickenpox vaccine). However, it is contraindicated during pregnancy or for breastfeeding patients due to risks of fetal or neonatal infection and pregnancy loss.
JYNNEOS is the vaccine that can be considered for pregnant patients at high risk for infection with monkeypox. Like ACAM2000, it contains a vaccinia virus, but it cannot replicate in the body or cause infection. While there are no data available for the use of JYNNEOS during pregnancy, other nonreplicating vaccines have been given in pregnancy without negative side effects.
Currently, the monkeypox outbreak is small and vaccines are available to patients at highest risk of infection. If you are a potential candidate for vaccination, your doctor will work with infectious diseases experts and the public health department to request the safest option for you.
Most people who get infected with monkeypox will not need treatment. The disease typically resolves on its own within a few weeks. However, ACOG recommends that risks and the benefits of treatment options be discussed due to the potential for negative pregnancy outcomes.
If you are concerned about your risk of exposure, or if you have symptoms of monkeypox, we will connect you with specialized care.