Maternal and neonatal outcomes after infection with monkeypox virus clade I during pregnancy in DR Congo: a pooled, prospective cohort study
Notice bibliographique
Résumé
BACKGROUND: Monkeypox virus (MPXV) has been linked to vertical transmission, but systematic data are scarce. We aimed to describe the sociodemographic, clinical, and virological characteristics and assess the frequency and determinants of adverse outcomes in pregnant women with MPXV clade I infection. METHODS: In this prospective cohort study, we pooled data from three cohort studies (MBOTE-SK, PREGMPOX, and Uvira mpox) and one randomised controlled trial (PALM007) conducted in the South Kivu, Maniema, and Sankuru provinces of DR Congo between Dec 29, 2022, and June 20, 2025. Pregnant women and adolescent girls with a PCR-confirmed diagnosis of mpox were followed up throughout hospitalisation for mpox, delivery, and until discharge during the postpartum period. We extracted data on sociodemographic characteristics, MPXV exposure, clinical and obstetric presentation, and laboratory results. In a univariable analysis, we examined factors associated with the following adverse outcomes: spontaneous or missed abortion (<20 weeks of gestation), stillbirth (≥20 weeks of gestation), preterm birth (<37 weeks of gestation), live birth of a neonate with macroscopic mpox-like lesions, early (first 7 days) neonatal death, congenital anomaly, or maternal death (during pregnancy or discharge postpartum). FINDINGS: We collected data from 89 pregnant women in the first (25 [28%]), second (31 [35%]), and third (33 [37%]) trimesters across all four studies: MBOTE-SK (36 [40%]), PREGMPOX (24 [27%]), PALM007 (25 [28%]), and Uvira mpox (four [4%]). All participants recovered from mpox; no maternal deaths were reported. During hospitalisation for mpox, fetal loss was reported in 17 (19%) women. Final pregnancy outcomes were known for 69 (78%) participants; adverse outcomes were reported in 35 (51%) women (95% CI 38-63), including fetal loss in 31 (45%; 95% CI 33-57; 16 [52%] spontaneous abortions, four [13%] missed abortions, and 11 [35%] stillbirths). Of the 38 live births, four neonates had congenital mpox-like lesions; one infant died a few hours after birth. No preterm births or congenital abnormalities were recorded. MPXV infection during the first trimester was associated with a higher risk of adverse pregnancy outcomes than during the second (risk ratio [RR] 0·6 [95% CI 0·4-0·9]) and third (0·2 [0·1-0·4]) trimesters (p=0·0008). Adverse outcomes were also associated with high viral load in skin lesions (PCR cycle threshold ≤30; RR 3·5 [95% CI 1·0-12·3]; p=0·045), direct sexual contact with the index case (1·6 [1·1-2·4]; p=0·026), positive HIV status (2·0 [1·4-2·9]; p=0·0002), and the presence of genital lesions (1·9 [1·1-3·2]; p=0·025). INTERPRETATION: MPXV clade I infection in pregnancy is associated with a high risk of fetal loss and congenital infection, particularly during the first trimester. Targeted preventive and clinical strategies are urgently needed to protect pregnant women and their infants in settings that are endemic and epidemic for mpox. FUNDING: The European and Developing Countries Clinical Trials Partnership, the Belgian Directorate-General Development Cooperation and Humanitarian Aid, the Swiss National Science Foundation, the Research Foundation-Flanders, the Gates Foundation, the Intramural Research Program of the National Institutes of Health, and the National Cancer Institute.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».