A study examines maternal and neonatal outcomes following monkeypox clade I infection during pregnancy in the Democratic Republic of the Congo. This is a pooled prospective cohort study. MPXV clade I infection in pregnancy is associated with a high risk of fetal loss. There is also a high risk of congenital infection. These risks are especially during the first trimester of pregnancy. Targeted preventive and clinical strategies are urgently needed. These strategies protect pregnant women and their infants in mpox endemic and epidemic areas.