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 hep atitis E virus (HEV) infection in Indian pregnant women is scanty. Only a f ew studies have been done so far to document the vertical route of transmis sion 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 potentia l 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 I gM anti-HEV (group A) and 30 (60%) were negative for IgM anti-HEV antibodie s (group B). Overall 19 patients were in their second trimester while 30 we re in third trimester. Of these 52.6 per cent (10/19) of those in second tr imester and 50 per cent (15/30) in third trimester had fulminant hepatic fa ilure (FHF). Only one patient presented in the first trimester who had acut e 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 se cond trimester of pregnancy. A similar percentage of patients i.e.. 14 of 2 0 (70%) manifested with FHF while 6 (30%) had acute hepatitis leading to re covery. The percentage of women with FHF and acute hepatitis was 36.6 and 6 3 per cent, respectively, in group B. Upon follow up all the 13 of the 14 H EV infected patients with FHF expired and only one delivered a male baby du ring the illness. The fatality rate in HEV infected patients was not differ ent between the second and third trimesters (66.6% vs. 71.43%, respectively ). Interpretation & conclusions. This study suggests that HEV causes high mort ality in pregnant women as compared to non-HEV infected pregnant women. Thi s pilot study indicates that steps should be taken to prevent HEV infection during pregnancy.