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Monkeypox & Pregnancy: Symptoms, Risks & Treatment


After more than two years in a pandemic, reports of a newly spreading virus can feel incredibly stressful. Nearly 12,000 cases of monkeypox have been identified in the United States,[1] and both the World Health Organization (WHO)[2] and the Biden-Harris administration have now declared the illness a public health emergency.[3]

It’s natural to have questions about monkeypox and what it means for your pregnancy. While experts stress that this illness is not COVID-19, there are a few things that are important to know about monkeypox and its potential impact on pregnant people. Here’s a breakdown.

What is monkeypox?

Monkeypox is a disease that is caused by the monkeypox virus, according to the Centers for Disease Control and Prevention (CDC).[4] It is not a new illness: The first human case of monkeypox was reported in 1970 in the Democratic Republic of Congo. Since then, other cases of the virus, which is related to the variola virus that causes smallpox, have been reported in other central and western African countries.

Prior to the current outbreak, the last documented cases of monkeypox in the U.S. occurred in 2003, the CDC says, when a small outbreak led to 47 confirmed and probable cases that were believed to be caused by a shipment of animals imported from Ghana.[5]

The virus is spread through close, personal, often skin-to-skin contact, the CDC says. That can include direct contact with monkeypox rash, scabs or body fluids from a person with monkeypox; touching objects, fabrics and surfaces that have been used by someone with monkeypox; contact with infected respiratory secretions; and spreading the virus to a fetus through the placenta.[6]

What are the symptoms of monkeypox?

Monkeypox goes through different phases during the course of two to four weeks. It usually starts with these symptoms:[7]

  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion

A few days after symptoms start, a person will usually get a rash that can spread. The bumps of the rash go through different stages before they fall off:

  • Enanthem (sometimes lesions first form on the tongue and in the mouth)
  • Macules (flat, discolored bumps)
  • Papules (raised area of skin)
  • Vesicles (blisters)
  • Pustules (small, pus-filled bumps)
  • Scabs (crusty bumps)

How does monkeypox affect pregnant women?

Experts are still learning how monkeypox might impact pregnant women, and there are a lot of unknowns.

“Information about monkeypox in pregnancy is very limited,” says Michael Cackovic, M.D., a maternal-fetal medicine physician at the Ohio State University Wexner Medical Center. “There have only been five confirmed cases in pregnancy in the world.”

The CDC also says it’s “unknown” if pregnant women are more susceptible to the monkeypox virus, or if it causes a more severe infection in pregnancy.[8]

“Theoretically, there is a concern that monkeypox could be more severe during pregnancy,” says Thomas Russo, M.D., professor and chief of infectious diseases at the University at Buffalo in New York. “However, we’d like a larger database to sort out whether that’s actually the case.”

Dr. Cackovic says it’s “plausible” monkeypox could cause more severe illness during pregnancy, “as other orthopoxviruses, viruses in the same family, do cause more severe disease in pregnancy with smallpox being one example.”

However, the good news is that monkeypox is still a rare illness.

How is monkeypox treated during pregnancy?

There are no specific treatments for monkeypox, Dr. Cackovic notes, and most people get better on their own without treatment. However, the CDC recommends using an antiviral drug called tecovirimat (TPOXX) as a “first-line” treatment “if treatment is indicated” during pregnancy. (Tecovirimat is also considered the go-to drug for non-pregnant people with monkeypox.)

Can pregnant women receive vaccines for monkeypox?

The CDC says that the JYNNEOS vaccine for monkeypox can be offered to pregnant people. However, the organization notes that human data is “insufficient” to determine if there are any risks to using the vaccine during pregnancy. The agency does say, though, that studies of JYNNEOS in animals have shown no harm to a developing fetus.

How can pregnant women keep themselves safe?

The main way that monkeypox is spreading in the U.S. right now seems to be through skin-to-skin contact, often from sexual encounters, Dr. Russo points out. The vast majority of monkeypox cases in the U.S. have been from men who have sex with men. Experts recommend doing your best to know your sexual partner or partners and anyone else they’ve been in contact with.

Dr. Russo also suggests doing your best to avoid skin-to-skin contact with someone with an obvious rash, just to be safe. 

If you develop symptoms of monkeypox, call your doctor. You should also contact your health care provider if you know you’ve been exposed to someone who has tested positive for the virus. 

That said, moms-to-be should feel reassured that monkeypox is still a rare illness and most people get better without treatment.

“The most important thing is to be cognizant that this exists,” says Rajeev Fernando, M.D., an infectious diseases physician and member of the What to Expect Medical Review Board. “Knowing is half the battle.”





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