The Impact of Monkeypox Virus Infection on Pregnancy Outcome: Clinical Features and Potential Pathogenic Mechanisms

Monkeypox has garnered significant attention following its emergence in multiple countries and its designation as a global health emergency in 2022. There is a notable deficiency in clinical and experimental data regarding pregnancy outcomes following monkeypox infection. The complications associated with monkeypox virus (MPXV) infection, including fetal miscarriage, preterm delivery, and congenital infections, have not been adequately addressed, and there is a lack of effective clinical interventions. Two clades of MPXV have been identified: clades I and II, with clade I being the predominant strain previously associated with adverse pregnancy outcomes. Clade IIb has also been implicated in potential vertical transmission from mother to child. Infection of a pregnant individual with MPXV can lead to fetal conditions, such as generalized diffuse herpes hydatidis and extensive hemorrhage within the placenta. MPXV is thought to evade the immune response primarily by inhibiting interferon (IFN)-mediated antiviral effects, suppressing host immune recognition, dampening host inflammatory responses, and modulating cellular apoptosis. This review aims to provide a comprehensive overview of the clinical manifestations, potential routes of vertical transmission, and possible pathogenic mechanisms of MPXV infection in pregnant women, thereby serving as a valuable reference for future diagnostic, therapeutic, and pharmacological strategies in managing MPXV-related pregnancy complications.