To the Editor:
The article of D'Antonio et al
1
demonstrated the effect of monkeypox infection on both maternal and fetal outcomes. Although the authors gathered all relevant literature regarding the specified outcomes, the results of this article should be interpreted with great caution. First, the authors did a meta-analysis of 4 case reports, in which 3 case reports contained only 1 patient. According to Murad et al,2
the inclusion of single-case reports in a meta-analysis leads to biased results in either a positive or a negative direction. Therefore, a meta-analysis is not the right approach to report the literature review regarding maternal and fetal outcomes in pregnancies complicated by monkeypox infection, and only a qualitative approach is recommended for such scarcity of data—that is, too many single-case reports—based on Murad et al's2
recommendations. Second, there is a high probability of duplicate patients in the studies of Ogoina et al3
and Yinka-Ogunleye et al,4
as both studies were conducted in Nigeria during the outbreak (2017–2018) and as the outcomes were the same in both studies.References
- Monkeypox infection in pregnancy: a systematic review and metaanalysis.Am J Obstet Gynecol MFM. 2022; 5100747
- Methodological quality and synthesis of case series and case reports.BMJ Evid Based Med. 2018; 23: 60-63
- Clinical course and outcome of human monkeypox in Nigeria.Clin Infect Dis. 2020; 71: e210-e214
- Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report.Lancet Infect Dis. 2019; 19: 872-879
Article info
Publication history
Published online: November 09, 2022
Accepted:
October 3,
2022
Received:
September 29,
2022
Footnotes
The author reports no conflict of interest.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
