Maternal and Fetal Outcomes in Pregnant Women with Acute Hepatitis E Virus Infection

Abstract

Pregnant women with jaundice and acute viral hepatitis caused by HEV infection had a higher maternal mortality rate and worse obstetric and fetal outcomes than did pregnant women with jaundice and acute viral hepatitis caused by other types of viral hepatitis.

Hepatitis E virus replication and interferon responses in human placental cells

“…Maternal mortality rates of about 25% in association with fulminant hepatic failure have been observed in HEV‐infected pregnant women,18 and the human placenta was also implicated as an extrahepatic replication site of HEV. Notably, vertical transmission has been shown to occur frequently,19 and adverse fetal outcome, especially in the third trimester, include preterm delivery, abortion, stillbirth, and intrauterine fetal and neonatal death 18, 20, 21. However, the underlying pathologic and virologic mechanisms of an HEV gt1 infection during pregnancy remain largely undefined.…”

Hepatitis E and Acute Liver Failure in Pregnancy

“…Various reports evaluating etiological spectrum in individuals with acute hepatitis during both epidemic and sporadic settings indicate three distinct observations in India: 1) HEV is the commonest cause of AVH in both sporadic and epidemic settings [3][4][5][6][7][8][9][10] 2) The frequency of HEV as the cause of AVH is significantly higher among pregnant females than in non-pregnant females and males 24,25,[42][43][44][45][46][47] 3) The frequency of ALF is significantly higher in pregnant females than in non-pregnant females and males with HEV infection. 7,24,25,43,45 Tables 3 and 4 7,11,12,[42][43][44][45][46][48][49][50] highlight the sporadic and epidemic studies of HEV induced AVH/ALF reported in pregnant females.…”

“…7,24,25,43,45 Tables 3 and 4 7,11,12,[42][43][44][45][46][48][49][50] highlight the sporadic and epidemic studies of HEV induced AVH/ALF reported in pregnant females.…”

“…In prospective studies evaluating pregnant patients with acute hepatitis caused by HEV, progression to ALF has been reported in 15-60% of patients. 25,45 In two prospective, comparative studies from Kashmir and Delhi, 55-70% of pregnant women and girls with HEV hepatitis compared with 10%-20% of pregnant women and girls with non-HEV hepatitis progressed to liver failure. 25,45 Hence, increased attack rates of HEV hepatitis and increased progression to liver failure during pregnancy together translate into a higher proportion of ALF during pregnancy in endemic areas.…”

“…The maternal complications include preterm labor, spontaneous abortions and death due to acute liver failure. 45 A study from North India, involving 132 pregnant women with HEV infection, reported obstetric complications in the form of antepartum hemorrhage (23%), postpartum hemorrhage (14%) and premature rupture of membranes (9%). Coagulopathy is responsible for the increased risk of bleeding seen in these patients.…”