Published: 2016-12-15

Maternal and fetal outcome in pregnancy with hepatitis E virus infection

Sunil Yadav, Sneha Shirodker, Swapnali Kshirsagar


Background: Hepatitis E infection has been a major concern in the pregnant females due to its fulminant nature in pregnancy and increased mortality in pregnant females as compared the non-pregnant females and males. In spite of approximately 60 years of its discovery the cause of fulminant nature of hepatitis E in pregnancy still remains a mystery. The maternal and fetal outcomes are still unfavorable. Various studies and hypothesis have been given but still not proved. Hence the study was performed in tertiary care centre to evaluate the maternal and fetal outcome in pregnancy with hepatitis E virus infection.

Methods: All cases of hepatitis E, IgM positive visiting the antenatal clinic or admitted during the period of 2012 and 2014 at the tertiary care centre were included in the study. Other cases of hepatitis (noninfectious, other causes of viral hepatitis) were excluded. Maternal outcome in terms of acute liver failure, coagulation failure, hepatic encephalopathy and maternal mortality was studied. Fetal outcome in terms of, preterm labor, low birth weight, intrauterine fetal death was studied.

Results: In the study it was found that pregnant women with jaundice and acute viral hepatitis due to hepatitis E virus infection had a high mortality rate (52%), especially during third trimester and postpartum period (82%). The most common medical complication was coagulation failure (56%) and acute liver failure (27%) followed by hepatic encephalopathy (17%). The most common obstetric complication was post-partum hemorrhage (42%) followed by IUFD (24%), APH (8%).

Conclusions: The study shows that pregnant women with jaundice and acute viral hepatitis due to hepatitis E virus infection had a high mortality rate especially during third trimester and postpartum period and also they had poor obstetric and fetal outcome.


Hepatitis E virus, Jaundice, Maternal mortality

Full Text:



Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55(4):988-97.

Viswanathan R. Infectious hepatitis in Delhi (1955–56): A critical study. Epidemiology. Indian J Med Res. 1957;45:1-29.

Dhamdhere MR, Nadkarni MG. Infectious hepatitis at Aurangabad. Report of an outbreak. Indian J Med Sci. 1962;16:1006-15.

Khuroo MS. Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. Am J Med. 1980;68:818-24.

Emerson SU, Anderson D, Arankalle VA. Hepevirus. In: Fauquet CM, Mayo MA, Maniloff J, Desselberger U, Ball LA, eds. Virus Taxonomy, VIIIth Report of the ICTV. London: Elsevier/Academic Press, 2004:851-5.

Mellor AL, Sivakumar J, Chandler P. Prevention of T cell driven complement activation and inflammation by tryptophan catabolism during pregnancy. Nat Immunol. 2001;2:64.

Orsi NM, Gopichandran N, Ekbote UV, Walker JJ. Murine serum cytokines throughout the estrous cycle, pregnancy and post-partum period. Anim Reprod Sci. 2006;96:54-65.

Bradley DW, Purdy MA. Molecular and serological characteristics of hepatitis E virus. In: Nishioka K, Suzuki H, Mishiro S, Oda T (eds). Viral hepatitis and liver disease. Tokyo:Springer-Verlag; 1994:125-31.

Panda SK, Nanda SK, Zafrullah M, Ansari IH, Ozdener MH, Jameel S. An Indian strain of hepatitis E virus (HEV): Cloning, sequence, and expression of structural region and antibody responses in sera from individuals from an area of high-level HEV endemicity. J Clin Microbiol 1995;33:2653-9.

Khuroo MS, Kamili S, Jameel S. Vertical transmission of hepatitis E virus. Lancet. 1995;345:1025-1026.

Sultana R, Humayun S. Fetomaternal outcome in acute hepatitis e. J Coll Physicians Surg Pak. 2014;24(2):127-30.

Shinde N, Patil T, Deshpande A, Gulhane R, Patil M, Bansod Y. Clinical profile, maternal and fetal outcomes of acute hepatitis e in pregnancy. Ann Med Health Sci Res. 2014;4(2):133-9.

Shrestha P, Bhandari D, Sharma D, Bhandari BP. A study of viral hepatitis during pregnancy in Nepal Medical College Teaching Hospital. Nepal Med Coll J. 2009;11:192-4.

Brohi ZP, Sadaf A, Perveen U. Etiology, clinical features and outcome of fulminant hepatic failure in pregnancy. J Pak Med Assoc. 2013;63(9):1168-71.

Patra S, Kumar A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes inpregnant women with acute hepatitis E virus infection. Ann Intern Med. 2007;147(1):28-33.

Khuroo MS, Kamili S, Yattoo GN. Severe fetal hepatitis E virus infection is the possible of increased severity of hepatitis E virus infection in the mother: another example of mirror syndrome. Indian J Gastroenteral. 2004;23(1):A1.

Zhuang H, Cao X, Liu C, Wang G. Enterically transmitted non-A, non-B hepatitis in China. In Viralhepatitis C, D and E, Shikata T, Purcell R, Uchida T(eds). Elsevier Science: Amsterdam, 1991; 277-285.

Dienstag J. Non-A, non-B hepatitis. I. Recognition, epidemiology, and clinical features. Gastroenterol. 1983;85:439-62.

Xu B, Yu HB, Hui W, He JL, Wei LL, Wang Z, Guo XH. Clinical features and risk actors of acute hepatitis E with severe jaundice. World J Gastroenterol. 2012;18(48):7279-84.

Rein DB, Stevens G, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus. Hepatology. 2012;55:988-97.

Hussaini SH, Skidmore SJ, Richardson P. Severe hepatitis E infection during pregnancy. J Viral Hepatol. 1997;4:51-4.

Jaiswal SP, Jain AK, Naik G, Soni N, Chitnis DS. Viral hepatitis during pregnancy. Int J Gynaecol Obstet. 2001;72(2):103-8.

Singh N, Shukla MM, Sharma VP. Epidemiology of malaria in pregnancy. Bull. WHO. 1999;77:567.

Beniwal M, Kumar A, Kar P. Prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy: a prospective study from north India. Indian J Med Microbiol. 2003;21(3):184-5.

Banait VS, Sandur V, Parikh F, Murugesh M, Ranka P, Ramesh VS, Sasidharan M, Sattar A, Kamat S, Dalal A, Bhatia SJ. Outcome of acute liver failure due to acute hepatitis E in pregnant women. Indian J Gastroenterol. 2007;26(1):6-10.

Kumar A, Beniwal B, Kar P. Hepatitis E in pregnancy. Obstetric Gynecol Surv. 2005;60:7-8.

Pal R, Aggarwal R, Naik SR, Das V, Das S, Naik S. Immunological alterations in pregnant women with acute hepatitis E. J Gastroenterol Hepatol. 2005;20:1094-101.

Navaneethan U, Mohajer M, Shata MT. Hepatitis E and pregnancy: Understanding the pathogenesis. Liver Int. 2008;28:1190-9.

Devhare PB, Chatterjee SN, Arankalle VA, Lole KS. Analysis of antiviral response in human epithelial cells infected with hepatitis E virus. PLoS One. 2013;8:63793.

Tripathy AS, Das R, Rathod SB, Arankalle VA. Cytokine profiles, CTL response and T cell frequencies in the peripheral blood of acute patients and individuals recovered from hepatitis E infection. PLoS One. 2012;7:31822.

Srivastava R, Aggarwal R, Jameel S, Puri P, Gupta VK, Ramesh VS, et al. Cellular immune responses in acute hepatitis E virus infection to the viral open reading frame 2 protein. Viral Immunol. 2007;20:56-65.