Outcome of hepatitis E virus infection in Indian pregnant women admitted to a tertiary care hospital

Background & objectives. Information on the incidence and prevalence of hepatitis E virus (HEV) infection in Indian pregnant women is scanty. Only a few studies have been done so far to document the vertical route of transmission of this virus. We therefore studied the prevalence of HEV infection in pregnant women with hepatitis and the outcome of their pregnancy. Methods. Fifty pregnant women with clinical hepatitis were included in the study. After informed consent, their blood samples were tested for potential causes of hepatitis including hepatitis A, B, hepatitis C, and hepatitis E infections. Results. Of the 50 cases, 20 (40%) patients were found to be positive for IgM anti-HEV (group A) and 30 (60%) were negative for IgM anti-HEV antibodies (group B). Overall 19 patients were in their second trimester while 30 were in third trimester. Of these 52.6 per cent (10/19) of those in second trimester and 50 per cent (15/30) in third trimester had fulminant hepatic failure (FHF). Only one patient presented in the first trimester who had acute viral hepatitis (AVH) and recovered completely. Of the HEV infected women, 70 per cent were in their third trimester and remaining 30 per cent in second trimester of pregnancy. A similar percentage of patients i.e.. 14 of 20 (70%) manifested with FHF while 6 (30%) had acute hepatitis leading to recovery. The percentage of women with FHF and acute hepatitis was 36.6 and 63 per cent, respectively, in group B. Upon follow up all the 13 of the 14 HEV infected patients with FHF expired and only one delivered a male baby during the illness. The fatality rate in HEV infected patients was not different between the second and third trimesters (66.6% vs. 71.43%, respectively). Interpretation & conclusions. This study suggests that HEV causes high mortality in pregnant women as compared to non-HEV infected pregnant women. This pilot study indicates that steps should be taken to prevent HEV infection during pregnancy.