A new paper published in Ultrasound in Obstetrics & Gynecology today brings together available evidence on monkeypox in pregnancy to provide healthcare professionals and pregnant women with advice on how to manage the virus.
There have been a number of cases detected in the UK and globally where cases among the population have been gradually rising since the start of May.
The UK Health Security Agency (UKHSA) says the risk to the public remains low, but encourages people to be alert to any new rashes or lesions.
The paper written by a collaboration of researchers in obstetric and paediatric medicine covers diagnosis of monkeypox in pregnant women and babies, treatment and recommended modes of birth.
Commenting on the paper, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:
“This paper written by leading medical experts synthesises available evidence on the monkeypox virus and makes recommendations on what needs to be done to ensure a pregnant woman and her baby are cared for if they have, or are suspected of having, the virus.
“The World Health Organisation states there could be adverse consequences for pregnant women and babies if they become infected including congenital monkeypox, miscarriage or stillbirth, which is why we have provided clear guidance for healthcare professionals in this paper.
“We are aware infants and children are at greater risk of becoming seriously ill if they do catch monkeypox. Therefore to minimise the risk of a baby contracting the virus, we recommend healthcare professionals discuss the benefits and risks of having a caesarean birth with a pregnant woman or person who has or is suspected of having the virus.”
Dr Camilla Kingdon, President of the Royal College of Paediatrics and Child Health (RCPCH) and Dr Helen Mactier, President of British Association of Perinatal Medicine (BAPM) said:
“There is a shortage of information at present about the spread of monkeypox in the UK, and its impact on pregnant women and newborns. This paper is therefore an important source of information to aid clinicians at a time when the numbers of cases in the UK is rising. We would urge all paediatricians to familiarise themselves with its content as although the risks are low, there is important advice that can reduce the risk of neonatal infection. “
The RCOG, RCPCH and Royal College of Midwives (RCM) will shortly be producing a guidance resource for healthcare professionals.
ENDS
For media enquiries please contact the RCOG press office on +44 (0)7740 175342 or email pressoffice@rcog.org.uk.
Notes to editor:
To view the paper, visit: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.24968
To find out the latest on moneypox from UKHSA visit: https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates
Q&A on monkeypox and its impact on pregnancy and childbirth
These Q&As are based on an Opinion article entitled Monkeypox and pregnancy: what do obstetricians need to know? Published in Ultrasound in Obstetrics & Gynecology on 2 June 2022: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.24968
What do we know about monkeypox so far?
An outbreak of monkeypox affecting multiple countries began in early May 2022. This is the first outbreak outside Africa for which the source cannot as yet be directly traced back to West or Central Africa, where this disease is endemic. The current outbreak is due to the West African clade of monkeypox not the central African clade which has historically caused more severe disease.
How is it transmitted?
The highest risk of transmission is considered to be through direct contact with a confirmed case, droplets or contaminated surfaces and objects. There is currently no evidence that monkeypox virus is sexually transmitted.
The highest risk period for transmission is understood to be from the onset of early symptoms until lesions have scabbed over and the scabs have fallen off.
A person will usually be infected with the disease between 6 -13 days but it can range from 5 to 21 days.
What are the symptoms?
The first symptoms of monkeypox include a high temperature, a headache, muscle aches, backache, swollen glands, shivering (chills) and exhaustion.
A rash usually appears 1 to 5 days after the first symptoms. The rash often begins on the face, then spreads to other parts of the body. This can include the genitals.
Do I have to self-isolate if I have monkeypox?
People with possible, probable or confirmed monkeypox are being asked to avoid contact with other people until their lesions have healed and the scabs have dried off.
I’m pregnant and have tested positive for monkeypox, will me or my baby be at risk?
In adults, monkeypox is usually mild and people recover in a few weeks without treatment.
There are very limited data on monkeypox infection in pregnancy.
The World Health Organisation (WHO) states that monkeypox during pregnancy may lead to complications, congenital monkeypox or stillbirth.
There is some limited evidence to show that the disease can be passed from woman to baby via the placenta, which can lead to congenital monkeypox.
If you are pregnant and have monkeypox, your maternity team will be able to discuss with you options for checking on the wellbeing of your baby during and after having the virus, such as additional ultrasounds.
What does it mean for my choice of birth if I have monkeypox?
It’s important your decision on how you wish to give birth is supported and respected by your maternity team.
A healthcare professional will be able to discuss the benefits and risks to you of having a vaginal birth or a caesarean birth if you have suspected or confirmed monkeypox.
There is no evidence around the optimal mode of birth in a woman with active monkeypox infection. However, if genital lesions are identified on a pregnant woman then a caesarean birth will be recommended. If a pregnant woman or person has suspected or confirmed monkeypox, a caesarean birth will be offered following discussion of the possible risk of neonatal infection, which may be serious.
Is there a risk to my baby after I have given birth?
There is evidence to show that close contact during and after birth can lead to monkeypox passing from a woman to her baby.
Although the evidence is limited, children and infants seem to be at the greatest risk of becoming severely ill with monkeypox.
To minimise the risk of the baby getting monkeypox, the baby will be isolated at birth from its parent or family members who have confirmed or suspected monkeypox. The baby will be carefully monitored for monkeypox infection by healthcare professionals. If the baby tests positive, the parent and baby can be reunited.
Can I still breastfeed if I have monkeypox?
The WHO advises against breastfeeding if a woman is infected with monkeypox. This will help to minimise the risk of neonatal monkeypox infection.
To support breastfeeding in the longer term, women who have been separated from their babies should be encouraged and supported to express and discard milk until her isolation period has passed or they have been reunited with their baby.
Is there a vaccine for monkeypox and is it recommended in pregnancy?
There is no specific vaccine against monkeypox, but the available smallpox vaccine is 85% effective in preventing monkeypox.
Administration of the vaccine up to 14 days post exposure may not prevent disease but may reduce severity of symptoms. In this outbreak, the advice is to vaccinate contacts of confirmed cases, including healthcare workers. It is also being offered to healthcare staff at risk of coming into contact with cases. Both groups include pregnant women and people.
Whilst no vaccine for use against monkeypox is approved in pregnancy, the UKHSA are recommending vaccination for pregnant women as the possible benefits in terms of preventing monkeypox outweigh any potential unknown risk.
The smallpox vaccine is a live non-replicating vaccine so there is no theoretical reason for concern about its use in pregnancy, and data from animal studies supports its use. Data are available from vaccination in fewer than 300 pregnant women and no adverse outcomes were found.
The decision whether to have the vaccine in pregnancy should be a personal choice. Pregnant women and people should be encouraged to discuss the risks and benefits of vaccination, including possible side-effects, with a healthcare professional before making their final decision.
Can I still breastfeed if I have the monkeypox vaccine?
Yes. The vaccine is considered safe in breastfeeding, as are other live vaccines such as rubella.
Any woman or person with a significant exposure to the virus should be offered vaccination, after consideration of the risks of monkeypox infection to them and their breastfeeding baby.