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Monkeypox in pregnancy

June 8, 2022

Original sources

Original scientific reports of monkeypox in pregnancy. Summaries, links, full texts, & citations, along the lines of our Covid-19 database (click here). No opinion, reviews, or guidelines. Just primary sources. Regularly updated by Susan Bewley, Keelin O’Donoghue, Kate Walker and me.

We’ve not listed primary sources for smallpox vaccine in pregnancy, but see reference list of study 10.

13 June 2022 – MP studies 7 to 10 added

MP study 10 – 376 women in smallpox vaccine in pregnancy registry

As of September 2006, pregnancy outcome data were available for 376 women enrolled in the Smallpox Vaccine in Pregnancy Registry (click here or study). Rates of pregnancy loss (11.9%), preterm birth (10.7%), or birth defects (2.8%), were judged comparable with those in healthy referent populations. No cases of fetal vaccinia were identified. Citation: Ryan MA, Seward JF; Smallpox Vaccine in Pregnancy Registry Team. Pregnancy, birth, and infant health outcomes from the National Smallpox Vaccine in Pregnancy Registry, 2003-2006. Clin Infect Dis. 2008 Mar 15;46 Suppl 3:S221-6. doi: 10.1086/524744. PMID: 18284362.

MP study 9 – 13 pregnancies in studies of Imvanex vaccine

Thirteen pregnancies occurred during five studies of Imvanex smallpox vaccine (Live Modified Vaccinia Virus Ankara). One was terminated with an elective abortion and one ended as spontaneous abortion. All others were followed up and all women gave birth to healthy babies (click here or study p109). These cases may overlap with those in study 7. Citation: European Medicines Agency 369203/2013 Committee for Medicinal Products for Human Use (CHMP) 30 May 2013. Accessed 13 June 2022

MP study 8 – no data on tecovirimat in pregnancy

Tecovirimat SIGA is indicated for the treatment of orthopoxvirus disease (smallpox, monkeypox,
cowpox, and vaccinia complications). There are no data on its use in pregnant women (click here or study p 30). Citation: European Medicines Agency 703119/2021. Committee for Medicinal Products for Human Use (CHMP)11 November 2021. Accessed 13 June 2022

MP study 7 – 14 pregnant women in trial of live, non-replicating smallpox and monkeypox vaccine

In this Federal Drug Administration report 24 women became pregnant during controlled trials of the Live, Non-replicating Smallpox and Monkeypox Vaccine, Modified Vaccinia Ankara BN (MVA-BN). 14 had received active vaccine or placebo. Five gave birth to healthy infants, and three had elective (non-medically indicated) abortions. In the MVA-BN group one had fetal death at ~12 weeks and one had a spontaneous abortion. In the placebo group, two had spontaneous abortions. Four women were lost to follow-up and the pregnancy outcomes are unknown (click here or study p 123). Citation: JYNNEOS, also referred to as Modified Vaccinia Virus Ankara–Bavarian Nordic (MVA-BN) FDA biologics license application. Clinical Review Memorandum 9/19/2019. Accessed 13 June 2022

11 June 2022 – MP study 5 added

MP Study 6 – five cases from the Democratic Republic of Congo

This preprint includes five pregnancy cases (click here or study), of which four had been previously described in MP study 1. No details are given of the new case except that this sentence in the abstract “fetal death occurred in 4 of 5 (80%) patients who were pregnant at admission” implies that the fetus died. Citation: Phillip R. Pittman, James W. Martin, Placide Mbala Kingebeni, Jean-Jacques Muyembe Tamfum, Qingwen Wan, Mary G. Reynolds, Xiaofei Quinn, Sarah Norris, Michael B. Townsend, Panayampalli S. Satheshkumar, Bryony Soltis, Anna Honko, Fernando B. Güereña, Lawrence Korman, John W. Huggins. Clinical characterization of human monkeypox infections in the Democratic Republic of the Congo. medRxiv 2022.05.26.22273379; doi: https://doi.org/10.1101/2022.05.26.22273379

8 June 2022 – MP studies 1-5 added

MP study 5 – No cases in pregnant women in present outbreak

As of 4 June 2022 no cases of monkeypox in pregnant women have been reported by WHO, either in endemic or non endemic areas (click here). Note the report does not explicitly state that no cases in pregnancy have ocurred. Citation: The World Health Organisation. Multi-country monkeypox outbreak: situation update. 4 June 2022. Accessed 8 June 2022

MP study 4 – no pregnant women in the 2003 USA outbreak

No infected pregnant women were reported in any of the CDC reports of the 2003 United States outbreak of monkeypox (click here for the latest update). Citation: Update: multistate outbreak of monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep 2003;52:589–90.

MP study 3 – secondary source for a case report from Zaire

“One case of probable congenital monkeypox in Zaire has been described. At approximately 24 weeks of
gestation, a pregnant woman developed a febrile illness with a rash; monkeypox virus was subsequently isolated from a vesicular lesion. Six weeks later she delivered a 1,500-g female infant with a generalized skin rash resembling monkeypox. The child died of malnutrition at 6 weeks of age.” The source is given as Jezek Z, Fenner F. Human monkeypox. New York (NY): Karger; 1988. [Not accessed]. Citation: Jamieson DJ, Cono J, Richards CL, Treadwell TA. The role of the obstetrician-gynecologist in emerging infectious diseases: monkeypox and pregnancy. Obstet Gynecol. 2004 Apr;103(4):754-6. doi: 10.1097/01.AOG.0000114987.76424.6d. PMID: 15051569.

MP study 2 – one case from Nigeria in 2017-18

One woman who was pregnant during her illness had a spontaneous abortion at 26 weeks (click here or study). Citation: Yinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, McCollum A, Disu Y, Mamadu I, Akinpelu A, Ahmad A, Burga J, Ndoreraho A, Nkunzimana E, Manneh L, Mohammed A, Adeoye O, Tom-Aba D, Silenou B, Ipadeola O, Saleh M, Adeyemo A, Nwadiutor I, Aworabhi N, Uke P, John D, Wakama P, Reynolds M, Mauldin MR, Doty J, Wilkins K, Musa J, Khalakdina A, Adedeji A, Mba N, Ojo O, Krause G, Ihekweazu C; CDC Monkeypox Outbreak Team. Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. Lancet Infect Dis. 2019 Aug;19(8):872-879. doi: 10.1016/S1473-3099(19)30294-4. Epub 2019 Jul 5. PMID: 31285143.

MP study 1 – four cases from the Democratic Republic of Congo

Four pregnant women treated in the General Hospital of Kole, in Sankuru District, Kasai Orientale Province, from March 2007 to July 2011. One was infected at six weeks (miscarriage at 9 weeks), one at 6-7 weeks (miscarriage at 8-9 weeks), one at 14 weeks (livebirth at term), and one at 18 weeks (fetal death at 21 weeks) (click here or study). Citation: 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 Oct 17;216(7):824-828. doi: 10.1093/infdis/jix260. PMID: 29029147.

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