Clinical profile, maternal and fetal outcomes of acute hepatitis e in pregnancy

Abstract

Background:Pregnant women are at increased risk of complications in hepatitis E virus (HEV) infection, with the risk increasing as the pregnancy progresses, often leading to fulminant hepatic failure and adverse fetal outcome.Aims:The primary objective of the following study is to evaluate the maternal and fetal complications of this infection and secondary aim is to compare the clinical features of hepatitis E in pregnant women to those in non-pregnant women.Subjects and Methods:This was a hospital based case-controls study, carried out from July 2008 to June 2010. Over a period of 2 years, cases were serologically confirmed pregnant women with hepatitis E, selected by screening in antenatal clinic. Controls were serologically confirmed non-pregnant women with hepatitis E, selected by screening in Medicine Outpatient Department. We studied 96 women with HEV infection, of which 52 were pregnant and 44 were non-pregnant. Clinical and laboratory profile of patients in both groups were studied. Patients were treated as per protocol and the outcome was studied in both groups. Pregnant women were followed-up for fetal and maternal outcome. We used t-test and z-test to compare normally distributed data and non-normally distributed data, respectively. Chi-square test was used to compare discrete values between groups.Results:Mean (standard deviation [SD]) age in pregnant patients was 24.1 (3.3) years while 32.6 (10.5) years in non-pregnant patients. 71.1% (37/52) of the patients were primigravida and 28.8% (15/52) patients were multigravida, by natural occurrence. Mean (SD) gestational age when infection occurred was 27.5 (7.2) weeks. Among pregnant women, 63.4% (33/52) were in 3rd trimester. Jaundice 1-5 days before presentation was seen in 51.9% (27/52) pregnant and 44.2% (23/44) non-pregnant women. Myalgia/arthralgia, fever, nausea/vomiting, right upper quadrant pain, jaundice, dark urine, light-colored stools, pruritus, diarrhea, altered sensorium and hematemesis/melena were presenting features. In pregnant group, 46.1% (24/52) patients developed encephalopathy while in non-pregnant group 34% (15/44) developed this complication. Among pregnant cases, 67.3% (35/52) survived and 32% (17/52) cases died. In non-pregnant group, nearly 90% (40/44) patients survived and only 9% (4/44) patients died. This difference was statistically significant (P < 0.01). Adverse fetal outcome was seen in 71.1% (37/52) pregnant women with acute hepatitis E, including pre-term delivery in 23% (12/52), stillbirth in 23% (12/52), abortion in 3.8% (2/52) and intra-uterine fetal death in 21.1% (11/52) patients.Conclusions:There is significantly higher occurrence of hepatitis E infection in pregnant women than in non-pregnant women, which increases with gestation, with associated fulminant hepatic failure, maternal mortality and worse fetal outcome.

Fetomaternal outcomes in pregnant women with hepatitis E infection; still an important fetomaternal killer with an unresolved mystery of increased virulence in pregnancy

“…Shinde et al ( 12 ) reported in their 2-year prospective study that 46.1% of pregnant patients developed encephalopathy compared with 34% in the non-pregnant group. Among the pregnant women, 67.3% survived and 32% died.…”

Hepatitis E virus seroprevalence in pregnant women in Jiangsu, China, and postpartum evolution during six years

“…Excluding the low detection efficiency of RT-nested PCR, the transient existence of viremia [ 38 ] or low viral load [ 39 ] in these patients may be the main reasons. Additionally, studies have demonstrated that HEV infection in pregnant women can result in intrauterine growth restriction, abortions, still births or neonatal death [ 3 , 4 ]. In the present study, we did not observe any adverse effects on the pregnant and neonatal outcomes in the three pregnant women with new infections.…”

“…It has been reported that a significant proportion of pregnant women with hepatitis E may progress to fulminant hepatitis during epidemics, especially in the third trimester, with a high mortality rate of 15–20 % [ 2 ]. On the other hand, although HEV is mainly transmitted by the fecal-oral route, epidemiological and clinical studies have suggested that vertical transmission of HEV may frequently happen in HEV infected pregnant women and lead to adverse fetal outcomes, such as miscarriage, stillbirth and neonatal death [ 3 , 4 ]. Moreover, although scarcely documented, the available data suggest secondary transmission of HEV may occur among family members both in outbreaks and sporadic infections [ 5 – 7 ].…”

Current Knowledge on Hepatitis E

“…Pregnant women are at increased risk of complications in HEV infection, with the risk increasing as the pregnancy progresses, often leading to fulminant hepatic failure and death in a high number of cases. 92 Acute HEV infection is especially severe during second and third trimesters of pregnancy, and it may lead to fulminant hepatic failure and death in 30–100% of patients. 93 There is also increased number of obstetric complications, e.g., premature rupture of membranes, postpartum hemorrhage, spontaneous abortions, and intrauterine fetal death.…”