Pregnant women are at high risk of severe mpox due to the immunological and hormonal changes of pregnancy. Clade I monkeypox virus (MPXV) is associated with more clinically significant adverse pregnancy outcomes and vertical transmission than clade II. The first probable case of MPXV clade I in pregnancy was reported in the Democratic Republic of Congo 8 years before delivery. In 4 women, there was transmission to newborns with generalized skin rashes consistent with mpox at approximately 7 months of pregnancy.