The risk of monkeypox infection remains low for the general public, the authors wrote, though cases continue to grow worldwide, particularly in the U.K.
“We are aware infants and children are at greater risk of becoming seriously ill if they do catch monkeypox,” Edward Morris, one of the authors and president of the Royal College of Obstetricians and Gynecologists, said in a statement.
“Therefore, to minimize 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 women or person who has or is suspected of having the virus,” he said.
Morris and colleagues pulled together existing evidence on monkeypox diagnosis, treatment, and recommended modes of birth for mothers and babies.
“The World Health Organization 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,” Morris said.
The monkeypox virus typically spreads through direct contact, droplets, or contaminated surfaces and objects. But some limited evidence shows that the virus can be passed from a mother to a baby via the placenta, which can lead to congenital monkeypox.
What’s more, mothers may be able to transmit the virus during or after birth. Although no evidence exists around the optimal mode of birth, a pregnant woman with an active monkeypox infection may choose to avoid vaginal delivery to reduce direct contact.
“If genital lesions are identified on a pregnant woman, then a caesarean birth will be recommended,” the authors wrote. “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.”
After giving birth, close contact can spread the virus as well. To minimize the risk, the authors recommend isolating the baby from family members who have confirmed or suspected monkeypox and carefully monitoring for infection.
Mothers with an active monkeypox infection should also avoid breastfeeding to lower the risk of spreading the virus to their newborn, the authors wrote. But to support breastfeeding after infection, mothers can express and discard milk until the isolation period has passed.
Pregnant women who become infected may also consider getting vaccinated, the authors wrote. Vaccination up to 14 days after exposure doesn’t prevent the disease but can reduce the severity of symptoms. In the current outbreak, public health organizations advised doctors to vaccinate contacts of confirmed cases, including pregnant people.
The data for monkeypox vaccine use in pregnant women is small, the authors wrote, including fewer than 300 women. In previous studies, no adverse outcomes were found. The vaccine is also considered safe for breastfeeding.
“The decision whether to have the vaccine in pregnancy should be a personal choice,” the authors wrote. “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.”
Ultrasound in Obstetrics & Gynecology: “Monkeypox and pregnancy: What do obstetricians need to know?”
Royal College of Obstetricians & Gynaecologists: “New paper provides best practice for managing monkeypox in pregnancy.”