Background: Monkeypox (Mpox) is an infectious disease caused by the virus, which has become a global concern in recent years. As a result of its outbreak, the World Health Organization (WHO) has twice declared monkeypox a global emergency, in June 2022 and on 14 August 2024. In cases of such diseases, pregnant and breastfeeding women are typically considered a sensitive or high-risk group; however, very few studies have been published on that group. Objective: This review aims to evaluate the risks of monkeypox virus infection in pregnant and breastfeeding women, assessing prevention strategies, safety measures, treatment options, and management protocols. Methods: we systematically searched for desired data in PubMed, ScienceDirect, Wiley Online, Scilit, and Google Scholar from 2009 to 2024. After removing duplicates, the search yielded 2031 results, of which 49 full-text papers were assessed for eligibility. From these, 32 studies were included in the final analysis. Results: It has been established that Mpox infection contributes to adverse maternal outcomes and complications such as miscarriage, fetal death, congenital Mpox, etc. This review noted that although there are some accessible guidelines for the treatment of Mpox in general, there is a severe lack of comprehensive protocols for pregnant and breastfeeding mothers. This article covers precautions such as vaccination and isolation, available therapies like tecovirimat, and guidelines on fetal monitoring. Conclusion: Finally, this paper proposes an integrated defense and treatment system for monkeypox prevention in pregnant and breastfeeding women, potentially aiding in determining prevalence and contributing to the third number goal of the Sustainable Development Goal (SDG).
References
[1]
Levitt, C.V., Tran, Q.K., Hraky, H., Mazer-Amirshahi, M. and Pourmand, A. (2023) Emergency Department Approach to Monkeypox. World Journal of Emergency Medicine, 14, Article 341. https://doi.org/10.5847/wjem.j.1920-8642.2023.098
[2]
Bragazzi, N.L., Woldegerima, W.A., Wu, J., Converti, M., Szarpak, L., Crapanzano, A., et al. (2024) Epidemiological and Clinical Characteristics of Mpox in Cisgender and Trans. Women and Non-Binary Individuals Assigned to the Female Sex at Birth: A Comprehensive, Critical Global Perspective. Viruses, 16, Article 325. https://doi.org/10.3390/v16030325
[3]
WHO (2024) WHO Director-General’s Opening Remarks at the Media Briefing Following the IHR Emergency Committee Meeting on the Upsurge of Mpox. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-following-the-ihr-emergency-committee-meeting-on-the-upsurge-of-mpox-2024---14-august-2024
[4]
World Health Organization (2024, August 26) Mpox. https://www.who.int/news-room/fact-sheets/detail/mpox
[5]
Abu-Azzam, O., Abu-Jeyyab, M., Daradkeh, M., Eldeen, S.Z., Zuaiter, S., Al-Mseadeen, M., et al. (2024) Monkeypox Infection and Pregnancy in Lower and Middle-Income Countries: Precautions & Recommendations. Revista Brasileira de Ginecologia e Obstetrícia, 46, e-rbgo54. https://doi.org/10.61622/rbgo/2024rbgo54
[6]
Hatmal, M.M., Al-Hatamleh, M.A.I., Olaimat, A.N., Ahmad, S., Hasan, H., Suhaimi, N.A.A., et al. (2022) Comprehensive Literature Review of Monkeypox. Emerging Microbes & Infections, 11, 2600-2631. https://doi.org/10.1080/22221751.2022.2132882
[7]
Altindis, M., Puca, E. and Shapo, L. (2022) Diagnosis of Monkeypox Virus—An Overview. Travel Medicine and Infectious Disease, 50, Article 102459. https://doi.org/10.1016/j.tmaid.2022.102459
[8]
Cabanillas, B., Murdaca, G., Guemari, A., Torres, M.J., Azkur, A.K., Aksoy, E., et al. (2023) A Compilation Answering 50 Questions on Monkeypox Virus and the Current Monkeypox Outbreak. Allergy, 78, 639-662. https://doi.org/10.1111/all.15633
[9]
Schwartz, D.A. (2024) High Rates of Miscarriage and Stillbirth among Pregnant Women with Clade I Mpox (Monkeypox) Are Confirmed during 2023-2024 DR Congo Outbreak in South Kivu Province. Viruses, 16, Article 1123. https://doi.org/10.3390/v16071123
[10]
Kim, S.B., Jung, J. and Peck, K.R. (2022) Monkeypox: The Resurgence of Forgotten Things. Epidemiology and Health, 44, e2022082. https://doi.org/10.4178/epih.e2022082
[11]
Mattar, R., Neto, A.R.B., Luz, A.G., Hatanaka, A., Zaconeta, A., Guazzelli, C.A.F., et al. (2022) Expert Recommendations on Monkeypox (MPX) in Pregnancy, Postpartum and Lactating Women. Revista Brasileira Ginecologia e Obstetrícia, 44, 1122-1125. https://doi.org/10.1055/s-0042-1759635
[12]
Clemente, N.S., Coles, C., Paixao, E.S., Brickley, E.B., Whittaker, E., Alfven, T., et al. (2024) Paediatric, Maternal, and Congenital Mpox: A Systematic Review and Meta-analysis. The Lancet Global Health, 12, e572-e588. https://doi.org/10.1016/S2214-109X(23)00607-1
[13]
Centers for Disease Control and Prevention (2022) Monkeypox and Pregnancy: Clinical Considerations. https://www.cdc.gov/mpox/hcp/clinical-care/pregnancy.html
[14]
Adler, H., Gould, S., Hine, P., Snell, L.B., Wong, W., Houlihan, C.F., et al. (2022) Clinical Features and Management of Human Monkeypox: A Retrospective Observational Study in the UK. The Lancet Infectious Diseases, 22, 1153-1162. https://doi.org/10.1016/S1473-3099(22)00228-6
[15]
Rampogu, S., Kim, Y., Kim, S.W. and Lee, K.W. (2023) An Overview on Monkeypox Virus: Pathogenesis, Transmission, Host Interaction and Therapeutics. Frontiers in Cellular and Infection Microbiology, 13, Article 1076251. https://doi.org/10.3389/fcimb.2023.1076251
[16]
Ogoina, D., Damon, I. and Nakoune, E. (2023) Clinical Review of HUMAN Mpox. Clinical Microbiology and Infection, 29, 1493-1501. https://doi.org/10.1016/j.cmi.2023.09.004
[17]
Sukhdeo, S., Mishra, S. and Walmsley, S. (2022) Human Monkeypox: A Comparison of the Characteristics of the New Epidemic to the Endemic Disease. BMC Infectious Diseases, 22, Article No. 928 https://doi.org/10.1186/s12879-022-07900-7
[18]
Eid, R.E., Allaw, F., Haddad, S.F., Kanj, S.S. (2022) Human Monkeypox: A Review of the Literature. PLOS Pathogens, 18, e1010768. https://doi.org/10.1371/journal.ppat.1010768
[19]
Harapan, H., Ophinni, Y., Megawati, D., Frediansyah, A., Mamada, S.S., Salampe, M., et al. (2022) Monkeypox: A Comprehensive Review. Viruses, 14, Article 2155. https://doi.org/10.3390/v14102155
[20]
Karagoz, A., Tombuloglu, H., Alsaeed, M., Tombuloglu, G., AlRubaish, A.A., Mahmoud, A., et al. (2023) Monkeypox (Mpox) Vius: Classification, Origin, Transmission, Genome Organization, Antiviral Drugs, and Molecular Diagnosis. Journal of Infection and Public Health, 16, 531-541. https://doi.org/10.1016/j.jiph.2023.02.003
[21]
Krishna, S., Kurrey, C., Yadav, M., Mahilkar, S., Sonkar, S.C., Vishvakarma, N.K., et al. (2024) Insights into the Emergence and Evolution of Monkeypox Virus: Historical Perspective, Epidemiology, Genetic Diversity, Transmission, and Preventative Measures. Infectious Medicine, 3, Article 100105. https://doi.org/10.1016/j.imj.2024.100105
[22]
Mitjà, O., Ogoina, D., Titanji, B.K., Galvan, C., Muyembe, J.J., Marks, M., et al. (2022) Monkeypox. The Lancet, 401, 60-74. https://doi.org/10.1016/S0140-6736(22)02075-X
Cheema, A.Y., Ogedegbe, O.J., Munir, M., Alugba, G. and Ojo, T.K. (2022) Monkeypox: A Review of Clinical Features, Diagnosis, and Treatment. Cureus, 14, e26756. https://doi.org/10.7759/cureus.26756
[25]
Tiecco, G., Antoni, M.D., Storti, S., Tomasoni, L.R., Castelli, F. and Quiros-Roldan, E. (2022) Monkeypox, a Literature Review: What Is New and Where Does This Concerning Virus Come from? Viruses, 14, Article 1894. https://doi.org/10.3390/v14091894
[26]
Nyame, J., Punniyakotti, S., Khera, K., Pal, R.S., Varadarajan, N. and Sharma, P. (2023) Challenges in the Treatment and Prevention of Monkeypox Infection; A Comprehensive Review. Acta Tropica, 245, Article 106960. https://doi.org/10.1016/j.actatropica.2023.106960
[27]
Spirito, F., Guida, A., Caponio, V.C.A. and Lo Muzio L. (2023) Monkeypox: A New Challenge for Global Health System? Life, 13, Article 1250. https://doi.org/10.3390/life13061250
[28]
Patel, M., Adnan, M., Aldarhami, A., Bazaid, A., Saeedi, N., Alkayyal, A., et al. (2023) Current Insights into Diagnosis, Prevention Strategies, Treatment, Therapeutic Targets, and Challenges of Monkeypox (Mpox) Infections in Human Populations. Life, 13, Article 249. https://doi.org/10.3390/life13010249
[29]
Anwar, F., Haider, F., Khan, S., Ahmad, I., Ahmed, N., Imran, M., et al. (2023) Clinical Manifestation, Transmission, Pathogenesis, and Diagnosis of Monkeypox Virus: A Comprehensive Review. Life, 13, Article 522. https://doi.org/10.3390/life13020522
[30]
Alakunle, E., Kolawole, D., Diaz-Cánova, D., Alele, F., Adegboye, O., Moens, U., et al. (2024) A Comprehensive Review of Monkeypox Virus and Mpox Characteristics. Frontiers in Cellular and Infection Microbiology, 14, Article 1360586. https://doi.org/10.3389/fcimb.2024.1360586
[31]
Letafati, A. and Sakhavarz, T. (2023) Monkeypox Virus: A Review. Microbial Pathogenesis, 176, Article 106027. https://doi.org/10.1016/j.micpath.2023.106027
[32]
Huang, Y.A., Howard‐Jones, A.R., Durrani, S., Wang, Z. and Williams, P.C. (2022) Monkeypox: A Clinical Update for Paediatricians. Journal of Paediatrics and Child Health, 58, 1532-1538. https://doi.org/10.1111/jpc.16171
[33]
Schwartz, D.A. and Pittman, P.R. (2023) Mpox (Monkeypox) in Pregnancy: Viral Clade Differences and Their Associations with Varying Obstetrical and Fetal Outcomes. Viruses, 15, Article 1649. https://doi.org/10.3390/v15081649
[34]
Daneji, S.M., Aminu, A., Borodo, A.M., Dayyab, F.M. (2022) Monkeypox in Human Pregnancy: An Overview. AJOG Global Reports, 2, Article 100130. https://doi.org/10.1016/j.xagr.2022.100130
[35]
Najimudeen, M., Chen, H.W.J., Jamaluddin, N.A., Myint, M.H. and Marzo, R.R. (2022) Monkeypox in Pregnancy: Susceptibility, Maternal and Fetal Outcomes, and One Health Concept. International Journal of Maternal and Child Health and AIDS, 11, 1-7. https://doi.org/10.21106/ijma.594
[36]
Schwartz, D.A., Ha, S., Dashraath, P., Baud, D., Pittman, P.R., Waldorf, K.M.A. (2023) Mpox Virus in Pregnancy, the Placenta, and Newborn. Archives of Pathology & Laboratory Medicine, 14, 746-757. https://doi.org/10.5858/arpa.2022-0520-SA
[37]
Kisalu, N.K. and Mokili, J.L. (2017) Toward Understanding the Outcomes of Monkeypox Infection in Human Pregnancy. The Journal of Infectious Diseases, 216, 795-797. https://doi.org/10.1093/infdis/jix342
[38]
Meaney-Delman, D.M., Galang, R.R., Petersen, B.W. and Jamieson, D.J. (2022) A Primer on Monkeypox Virus for Obstetrician-Gynecologists. Obstetrics and Gynecology, 140, 391-397. https://doi.org/10.1097/AOG.0000000000004909
[39]
Velázquez-Cervantes, M.A., Ulloa-Aguilar, J.M. and León-Juárez, M. (2022) Mpox, and Preg Nancy: A Neglected Disease and its Impact on Perinatal Health. RevistaClínica Española (English Edition), 223, 32-39. https://doi.org/10.1016/j.rceng.2022.09.002
[40]
Carvajal, A. and Gracia, P.V.D. (2022) Monkeypox and Preg Nancy. American Journal of Obstetrics & Gynecology MFM, 4, Article 100746. https://doi.org/10.1016/j.ajogmf.2022.100746
[41]
Dashraath, P., Nielsen-Saines, K., Rimoin, A., Mattar, C.N.Z., Panchaud, A. and Baud, D. (2022) Monkeypox in Pregnancy: Virology, Clinical Presentation, and Obstetric Management. American Journal of Obstetrics and Gynecology, 227, 849-861.e7. https://doi.org/10.1016/j.ajog.2022.08.017
[42]
Gaeta, F., De Caro, F., Franci, G., Pagliano, P., Vajro, P. and Mandato, C. (2022) Monkeypox Infection 2022: An Updated Narrative Review Focusing on the Neonatal and Pediatric Population. Children, 9, Article 1832. https://doi.org/10.3390/children9121832
[43]
D’Antonio, F., Pagani, G., Buca, D. and Khalil, A. (2023) Monkeypox Infection in Pregnancy: A Systematic Review and Metaanalysis. American Journal of Obstetrics & Gynecology MFM, 5, Article 100747. https://doi.org/10.1016/j.ajogmf.2022.100747
[44]
Mohamed, N.A., Zupin, L., Mazi, S.I., Al-Khatib, H.A. and Crovella, S. (2023) Nanomedicine as a Potential Tool Against Monkeypox. Vaccines, 11, Article 428. https://doi.org/10.3390/vaccines11020428
[45]
Zimmermann, P.M. and Curtis, N. (2022) Monkeypox—What Pediatricians Need to Know. The Pediatric Infectious Disease Journal, 41, 1020-1031. https://doi.org/10.1097/INF.0000000000003720
[46]
Morris, S., Joshi, P., Soni, P., Jakhmola, V., Sahiba, N., Kalita, K., et al. (2023) A Systematic Review on Human Monkeypox Virus Disease and Infection in Pregnancy. Journal of Pure and Applied Microbiology, 17, 650-659. https://doi.org/10.22207/JPAM.17.2.52
[47]
Khalil, A., Samara, A., O’Brien, P., Morris, E., Draycott, T., Lees, C., et al. (2022) Monkeypox and Pregnancy: What Do Obstetricians Need to Know? Ultrasound in Obstetrics and Gynecology, 60, 22-27. https://doi.org/10.1002/uog.24968
[48]
Yan, K., Tang, L.K., Xiao, F.F., Zhang, P., Lu, C.M., Hu, L.Y., et al. (2022) Monkeypox and the Perinatal Period: What Does Maternal-Fetal Medicine Need to Know? World Journal of Pediatrics, 19, 213-223. https://doi.org/10.1007/s12519-022-00630-5
[49]
Cuérel, A., Favre, G., Vouga, M. and Pomar, L. (2022) Monkeypox and Pregnancy: Latest Updates. Viruses, 14, Article 2520. https://doi.org/10.3390/v14112520
[50]
Abdelaal, A., Reda, A., Lashin, B.I., Katamesh, B.E., Brakat, A.M., Al-Manaseer, B.M., et al. (2022) Preventing the Next Pandemic: Is Live Vaccine Efficacious against Monkeypox, or Is There a Need for Killed Virus and mRNA Vaccines? Vaccines, 10, Article 1419. https://doi.org/10.3390/vaccines10091419
[51]
Goyal, L., Ajmera, K., Pandit, R. and Pandit, T. (2022) Prevention and Treatment of Monkeypox: A Step-by-Step Guide for Healthcare Professionals and General Population. Cureus, 14, e28230. https://doi.org/10.7759/cureus.28230
[52]
Elsayed, S., Bondy, L. and Hanage, W.P. (2022) Monkeypox Virus Infections in Humans. Clinical Microbiology Reviews, 35, e00092-22. https://doi.org/10.1128/cmr.00092-22
