Mpox in Pregnancy — Risks, Vertical Transmission, Prevention, and Treatment

This Perspective outlines the clinical, epidemiologic, and public health implications of mpox (monkeypox virus, MPXV) infection during pregnancy and breast-feeding. Drawing on recent outbreaks of clade I MPXV in the Democratic Republic of Congo (DRC) and neighboring countries, the authors highlight the elevated risks of miscarriage, stillbirth, and maternal mortality. Evidence from human cases and nonhuman primate models supports vertical transmission and severe fetal outcomes. The article reviews vaccine options (MVA-BN and LC16m8), antiviral therapy (tecovirimat), and diagnostic challenges, emphasizing the need for targeted research and inclusive clinical trials. A proposed research agenda includes studies on transmission dynamics, fetal outcomes, vaccine safety, and community engagement. The authors advocate for evidence-based guidelines and global investment in mpox preparedness, especially for vulnerable populations such as pregnant persons and sex workers.

This Perspective outlines the clinical, epidemiologic, and public health implications of mpox (monkeypox virus, MPXV) infection during pregnancy and breast-feeding. Drawing on recent outbreaks of clade I MPXV in the Democratic Republic of Congo (DRC) and neighboring countries, the authors highlight the elevated risks of miscarriage, stillbirth, and maternal mortality. Evidence from human cases and nonhuman primate models supports vertical transmission and severe fetal outcomes. The article reviews vaccine options (MVA-BN and LC16m8), antiviral therapy (tecovirimat), and diagnostic challenges, emphasizing the need for targeted research and inclusive clinical trials. A proposed research agenda includes studies on transmission dynamics, fetal outcomes, vaccine safety, and community engagement. The authors advocate for evidence-based guidelines and global investment in mpox preparedness, especially for vulnerable populations such as pregnant persons and sex workers.