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Clinical Considerations for Mpox in People Who are Pregnant or Breastfeeding
The signs and symptoms of MPXV infection in people who are pregnant appear similar to those in non-pregnant people with MPXV infection, including prodromal symptoms (e.g., fever, headache, lymphadenopathy, malaise, sore throat and cough) and rash.
During pregnancy, the cause of fever may be difficult to differentiate from other infections, such as intra-amniotic infection (chorioamnionitis), until the rash appears. Rash in a person who is pregnant with risk factors for mpox needs to be differentiated from dermatoses of pregnancy, including polymorphic eruption of pregnancy (also known as pruritic urticarial papules and plaques of pregnancy). In addition, mpox lesions can mimic those in other infections. Patients with rashes initially considered characteristic of more common infections (e.g., varicella zoster or sexually transmitted infections) should be carefully evaluated for a characteristic mpox rash (see images), and diagnostic testing should be considered, especially if the person has epidemiologic risk factors for MPXV infection. Co-infections of MPXV and sexually transmitted infections (STIs) and HIV have been reported and the presence of an STI does not rule out mpox, so a broad approach to testing is encouraged.
While most non-pregnant adults with an MPXV infection experience mild illness and recover spontaneously, pregnant, recently pregnant, and breastfeeding people should be prioritized for medical treatment if needed. This is because of the probable increased risk of severe disease during pregnancy, risk of transmission to the fetus during pregnancy or to the newborn by close contact during and after birth, and risk of severe infection in newborns.
Treatment for mpox should be offered, when indicated, to people who are pregnant, recently pregnant, or breastfeeding. The risks and benefits of treatment should be discussed with the patient using shared decision-making.
Close monitoring for severe disease and pregnancy complications is important. The decision to treat and monitor a pregnant person as an outpatient or in the inpatient setting should be individualized.
For information about skin and wound care for individuals with mpox lesions, please visit: Mpox: Caring for the Skin [165 KB, 2 pages] and Mpox: Treating Severe Lesions.
The benefits of skin-to-skin contact and rooming-in on breastfeeding and infant physiology are well known. However, given the risk of neonatal transmission of MPXV with close contact and potential for severe disease in newborns, direct contact between a patient in isolation for mpox and their newborn is not advised.
Separation (e.g., separate rooms) of a patient with mpox from their newborn is the best way to prevent transmission to the newborn. Full-time rooming in with a newborn is not recommended during a patient’s infectious period.
The patient should be counseled about the risk of transmission and the potential for severe disease in newborns. If the patient chooses to have contact with the newborn during the infectious period, strict precautions should be taken, including the following:
These precautions should be continued until criteria for discontinuing isolation have been met (i.e., all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed).
Discharge planning should take into account the duration of isolation, ability to strictly adhere to recommended isolation precautions, and availability of alternative caregivers.
Patients in isolation for mpox may experience increased stress because of separation from their newborns, and postpartum depression symptoms may be worsened. Providers are encouraged to share resources with patients about coping with stress [/mentalhealth/cope-with-stress/index.html] during this time.
Breast milk is the best source of nutrition for most newborns, and it provides protection against many illnesses. However, given that MPXV is spread by close contact and neonatal mpox infection may be severe, breastfeeding should be delayed until criteria for discontinuing isolation have been met (i.e., all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed).
Some people who are breastfeeding may need additional support from a lactation provider to initiate and maintain their milk production and avoid a breast infection while mpox lesions are healing.
It is unknown if MPXV is present in breast milk. Breast milk expressed from a patient who is symptomatic or isolated should be discarded while breastfeeding is delayed. To avoid inadvertently exposing an infant to MPXV, a healthy caregiver can feed pasteurized donor human milk or infant formula. People who are breastfeeding should talk with their healthcare provider to determine if their lesions have healed and they can resume direct breastfeeding or feed expressed breast milk.
Last Reviewed: June 11, 2024
Source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP)
