A guide to the management of hepatitis E infection during pregnancy

ABSTRACT

Introduction: Hepatitis E virus (HEV) infection has distinct features, depending upon the genotype and geographical area. HEV genotypes 1 and 2 are endemic to various developing countries causing epidemics of acute viral hepatitis with human to human transmission. On the other hand, HEV genotypes 3 and 4 prevalent in developed countries commonly lead to subclinical infection and are transmitted zoonotically. HEV infection typically causes acute self-limiting illness associated with low morbidity and mortality. Infection with HEV genotype 1 or 2 in pregnancy, especially in the third trimester may lead to severe illness and fulminant liver failure. Poor maternal and fetal outcomes have been reported.

Areas covered: This review highlights the various aspects of HEV infection in pregnancy including diagnosis, management, and prevention.

Expert commentary: Treatment is mainly supportive with diligent monitoring and intensive care. Therapeutic termination of pregnancy cannot be recommended based to the available literature. Early liver transplantation (LT) should be considered in these patients although the indications and timing of LT are still controversial. Prevention of HEV infection or illness by improved sanitation and active/passive immunization needs further research.

KEYWORDS:

• Hepatitis E
• pregnancy
• fulminant hepatic failure
• acute liver failure
• acute viral hepatitis
• treatment

Article highlights

• In developing countries, Hepatitis E (HEV 1/2) infection in pregnancy is associated with poor maternal and fetal outcomes, whereas in developed countries (HEV 3/4) it has a benign course.

• Fulminant hepatic failure and maternal mortality are more common in the third trimester.

• Treatment is mainly supportive with diligent monitoring and intensive care.

• Therapeutic termination of pregnancy is not recommended based on current evidence.

• Indications and timing of liver transplantation for ALF is controversial.

• Further research on prevention of HEV infection with active/passive immunization is necessary.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.