The management of monkeypox during pregnancy

The management of monkeypox during pregnancy

In a recently published correspondence in the American Journal of Obstetrics and Gynecology The authors responded and clarified some of the claims discussed in a letter to the editor accompanying their August 2022 article on predicting the risks of monkeypox in pregnant women.

Lernen: Herangehensweise an Affenpocken in der Schwangerschaft: Vermutungen lassen sich am besten durch Beweise leiten. Bildnachweis: Natalia Deriabina/Shutterstock

background

In a clinical opinion article published in the American Journal of Obstetrics and Gynecology, authors Dashraath et al. discussed the potentially increased risks of monkeypox in pregnant women. Some of the risks discussed included vertical transmission of the virus and, more importantly, reduced immunity in women of childbearing age due to depleted population immunity to orthopoxviruses such as smallpox virus.

In addition, the authors discussed possible pregnancy outcomes such as miscarriage and congenital infections. They further addressed concerns about administering the monkeypox vaccine during pregnancy and also suggested strategies to mitigate the risk of vertical transmission.

A recent one Letter to the editor written by Mungmunpuntipantip and Wiwanitki disputed some of the claims made by Dashraath et al. points discussed. and proposed alternative approaches to the management of monkeypox in pregnant women, including focusing on traditional disease prevention strategies.

The answer

In this correspondence, the authors address some of the claims made by Mungmunpuntipantip and Wiwanitki. Referring to the suggestion that fever and skin lesions are unusual symptoms and may be missed by doctors, leading to inaccurate diagnoses, the authors replied that although skin lesions are not obvious, the most commonly reported symptom remains the appearance of systemic, genital and oral skin rashes, according to the World Health Organization (WHO).

They added that the prevalence of asymptomatic patients is currently unknown and a better understanding of asymptomatic monkeypox cases is needed before recommending universal monkeypox screening for pregnant women.

In response to Mungmunpuntipantip and Wiwanitki's statement about patients with neurological and digestive problems showing only certain symptoms, the authors explained that gastrointestinal symptoms have not yet been included in WHO surveillance reports.

In addition, the authors reported that the predominant neurological manifestation of monkeypox is generalized or frontal headache, which is common during pregnancy. However, they advised obstetricians to be alert for atypical symptoms of monkeypox virus infection, particularly those associated with monkeypox-associated encephalomyelitis, such as muscle fatigue, incontinence, and altered mental status. They believe these symptoms may indicate the presence of the monkeypox virus in the central nervous system in previously healthy individuals.

Mungmunpuntipantip and Wiwanitki mentioned the problem of cross-contamination and inaccuracy of monkeypox virus testing and the need for good sampling methods. Given these problems, they emphasized the need to take atypical symptoms into account. The authors of the present correspondence noted that accreditation and evaluation of monkeypox testing laboratories are critical to ensure accurate results and prevent contamination of samples.

Finally, Mungmunpuntipantip and Wiwanitki referred to smallpox infections and argued that there was little evidence of vertical transmission from mother to fetus. They added that the size of the monkeypox virus makes it unlikely that it can cross the placenta.

In response, the authors discussed the detection of monkeypox viral deoxyribonucleic acid (DNA) in lesions of the fetus and placenta during labor using real-time polymerase chain reaction (rt-PCR). Furthermore, they added that the lack of evidence of vertical transmission could be due to socioeconomic barriers to scientific publication from countries where the disease was previously endemic.

Conclusion

In summary, in this correspondence the authors have addressed Mungmunpuntipantip and Wiwanitki's criticism of their previous clinical opinion on the assessment and management of the risks of monkeypox in pregnant women. The authors reiterated the need for further studies on the asymptomatic occurrence of monkeypox to understand the role of carriers in the spread of the disease. In addition, they warned obstetricians not to recognize signs of neurological manifestations of monkeypox.

While the issue of cross-contamination can be addressed through rigorous assessments of testing facilities, the authors stated that the risk of vertical transmission of monkeypox cannot be ruled out. The correspondence addressed possible pathogenic mechanisms of intrauterine virus transmission.

They concluded by stating that there is strong evidence of the negative consequences of monkeypox in pregnant women, including miscarriages, premature births and congenital infections, and that it poses a significant risk to the fetus and mother.

References:

• Baud, D., Nielsen-Saines, K. und Dashraath, P. (2022) „Ansatz zu Affenpocken in der Schwangerschaft: Vermutungen lassen sich am besten durch Beweise leiten“, American Journal of Obstetrics and Gynecology. doi: 10.1016/j.ajog.2022.09.029. https://www.sciencedirect.com/science/article/pii/S0002937822007621
• Mungmunpuntipantip, R. und Wiwanitkit, V. (2022) „MONKEYPOX AND PREGNANCY: Correspondence“, American Journal of Obstetrics and Gynecology. doi: 10.1016/j.ajog.2022.09.028. https://www.sciencedirect.com/science/article/abs/pii/S000293782200761X
• Dashraath, P., Nielsen-Saines, K., Rimoin, A., Mattar, C., Panchaud, A., & Baud, D. (2022). Affenpocken und Schwangerschaft: Vorhersage der Risiken. Amerikanisches Journal für Geburtshilfe und Gynäkologie. doi: https://doi.org/10.1016/j.ahog.2022.08.017

.