Winata I Gde Sastra, Leonardo Leonardo, Sylfiasari Rosalia, Ekafentie Angeline, Immanuel Surya Sinaga, Christyani Fenyta
Department of Obstetrics and Gynecology, Prof. Dr. I.G.N.G. Ngoerah General Hospital/Faculty of Medicine, Udayana University, Denpasar, Indonesia.
School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
Infect Chemother. 2025 Mar;57(1):119-130. doi: 10.3947/ic.2024.0120.
The global resurgence of mpox, formerly monkeypox, poses an emerging threat to pregnant women due to immunological changes and potential vertical transmission, yet its impact on pregnancy remains underexplored. This study aims to pioneer a comprehensive assessment of pregnancy outcomes and the risks of vertical transmission associated with mpox infection during pregnancy.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched three databases up to September 2024 for studies on pregnant women with mpox confirmed by quantitative polymerase chain reaction. Primary outcomes were composite adverse pregnancy outcomes: miscarriage or fetal death, congenital anomalies, and chorioamnionitis; the secondary outcome was vertical transmission. Study quality was assessed using Joanna Briggs Institute tools. Statistical analysis employed R software using a one-proportion model with Freeman-Tukey transformation and random-effects meta-analysis (restricted maximum-likelihood estimator, Knapp-Hartung adjustment), presenting estimated proportions with 95% confidence intervals (CIs).
Six studies (three case series, three case reports) comprising 11 singleton pregnancies were included. Diagnoses occurred in the first (27.3%), second (45.4%), and third trimesters (27.3%). Among the five genotypically identified Mpox cases, 20.0% were classified Clade I and 80.0% as Clade II. Meta-analysis indicated that an estimated 63% (95% CI, 43-83%) of pregnancies experienced composite adverse pregnancy outcomes. Specifically, miscarriage or fetal death occurred in 62% (95% CI, 21-102%), congenital anomalies in 50% (95% CI, 21-80%), and chorioamnionitis in 78% (95% CI, 44-96%). Vertical transmission was observed in 79% (95% CI, 6-151%). Despite small sample sizes leading to wide confidence intervals, high estimated proportions suggest that mpox severely impacts pregnancy outcomes, likely linked to maternal inflammation, placental invasion, and significant fetal risks from vertical transmission.
Mpox infection during pregnancy appears to be associated with high rates of adverse pregnancy outcomes and vertical transmission. Further large-scale studies are warranted to confirm these findings and develop preventive and management strategies mitigating this emerging threat.
曾被称为猴痘的猴痘在全球范围内再度流行，由于免疫变化和潜在的垂直传播，对孕妇构成了新出现的威胁，但其对妊娠的影响仍未得到充分研究。本研究旨在率先全面评估妊娠结局以及与孕期猴痘感染相关的垂直传播风险。
遵循系统评价和荟萃分析的首选报告项目指南，我们检索了截至2024年9月的三个数据库，以查找经定量聚合酶链反应确诊为猴痘的孕妇的研究。主要结局是复合不良妊娠结局：流产或胎儿死亡、先天性异常和绒毛膜羊膜炎；次要结局是垂直传播。使用乔安娜·布里格斯研究所工具评估研究质量。统计分析采用R软件，使用单比例模型并进行弗里曼 - 图基变换和随机效应荟萃分析（限制最大似然估计器，克纳普 - 哈通调整），呈现估计比例及95%置信区间（CI）。
纳入了六项研究（三项病例系列研究、三项病例报告），共11例单胎妊娠。诊断发生在孕早期（27.3%）、孕中期（45.4%）和孕晚期（27.3%）。在五例经基因分型鉴定的猴痘病例中，20.0%被归类为I分支，80.0%为II分支。荟萃分析表明，估计63%（95%CI，43 - 83%）的妊娠经历了复合不良妊娠结局。具体而言，流产或胎儿死亡发生率为62%（95%CI，21 - 102%），先天性异常发生率为50%（95%CI，21 - 80%），绒毛膜羊膜炎发生率为78%（95%CI，44 - 96%）。观察到垂直传播率为79%（95%CI，6 - 151%）。尽管样本量小导致置信区间宽，但估计比例高表明猴痘严重影响妊娠结局，可能与母体炎症、胎盘侵袭以及垂直传播带来的重大胎儿风险有关。
孕期猴痘感染似乎与高不良妊娠结局率和垂直传播率相关。有必要开展进一步的大规模研究以证实这些发现，并制定预防和管理策略来减轻这一新兴威胁。
Zotero 插件
