Clinical

Hepatitis E in pregnancy linked to poor maternal-fetal outcomes

Last Updated: 2007-07-20 16:59:24 -0400 (Reuters Health)

By C. Vidyashankar, MD

NEW YORK (Reuters Health) - Hepatitis E infection during pregnancy is associated with increased maternal mortality, obstetric complications, and poor fetal outcomes, according to results of a study from India.

Hepatitis E is a water-borne viral infection that is usually mild, but can produce severe infection leading to fulminant hepatic failure in pregnant women, co-author Dr. Ashish Kumar, from Lady Hardinge Medical College, Delhi, told Reuters Health.

Dr. Shiv Kumar Sarin and colleagues followed 220 women who were admitted with viral hepatitis during pregnancy.

Hepatitis E was responsible for 60% of acute viral hepatitis cases, Dr. Sarin and colleagues report in the July issue of Annals of Internal Medicine. Fulminant hepatic failure and coagulation abnormalities were more than twice as common in those women with hepatitis E compared to those with hepatitis due to other causes.

Increased intracranial tension was 18 times more likely among women with hepatitis E infection, and maternal mortality was six times more likely. Antepartum hemorrhage, intrauterine fetal death, preterm deliveries and stillbirth were also significantly greater among the hepatitis E group, the researchers add.

Vertical transmission of the virus could be responsible for the fetal effects of the hepatitis E, the researchers explain.

Immunologic imbalance associated with a predominant T helper 2 cell subtype response may be responsible for the severity of hepatitis E in pregnancy, the researchers postulate. Suppression of cell mediated immunity due to high levels of estrogen and progesterone in pregnancy could potentate this effect, they add.

Although the effects of hepatitis E on pregnant women were known before the study, the new research has "shown that not only does hepatitis E cause serious illness in pregnant mothers, but it also adversely affects the fetus," Dr. Kumar said.

There is no specific treatment for the virus, Dr. Kumar said. "Public health measures such as clean water supply, improved sanitation and public education are the major tools to prevent HEV infection in developing nations," he concluded.

Ann Inter Med 2007;147:28-33.