Introduction

Hepatitis E is a water-borne viral infection that affects the liver, it is caused by the hepatitis E virus (HEV). The virus spreads or is transmitted through the faecal-oral route via contaminated water sources and consumption of contaminated food such as eating undercooked meat from infected animals. 

Hepatitis E is found worldwide, but the infection is more likely to occur in low and middle-income countries in Asia, Africa, Central America and the Middle East where poor sanitation is commonplace and there is restricted access to clean drinking water and health services.¹ According to the WHO, annually, there are 20 million new cases of Hepatitis E virus, and over 44,000 deaths occurred due to this virus in 2015.²

Hepatitis E infection in pregnant women poses a significant risk to both the mother and the baby, especially during the later stages of pregnancy. For example, the WHO states that up to 20-25% of pregnant women can die if they get hepatitis E in their third trimester. ³

In this article, we will uncover what Hepatitis E is, why it is especially harmful for pregnant women, and how it can be kept at bay to reduce the risk of complications occurring to both the mother and the baby. Knowledge of the symptoms, treatment options and preventive measures can allow expectant mothers to protect themselves and their babies. 

Risks of hepatitis E in pregnancy

Pregnant women are at a higher risk in their last stage of pregnancy, which is called the third trimester, because they are at a high risk of developing complications. This is attributed to the immune system, which is naturally suppressed during pregnancy to allow the fetus to grow, which means that the mother is more likely to develop infections which can worsen over time.⁴

Potential complications for the mother

Hepatitis E infected individuals are likely to face a range of complications such as fulminant hepatitis, which is a sudden and extreme form of severe hepatitis that occurs in a matter of weeks. Pregnant women are also at a risk of developing complications during childbirth, which may include events such as increased blood loss or hemorrhage. HEV-infected women also have a higher mortality rate of 41% compared to pregnant women who have not been infected with hepatitis E at 7%.⁵

Potential risks to the baby

There are also potential risks to the baby, which include pre-term delivery, which means that the baby is born much earlier than the estimated date of delivery with a low birth weight, which makes the baby frail and weak. Stillbirth or fetal death is also a very serious and dangerous complication that may unfortunately occur in pregnant women affected by HEV.⁵

These life-threatening risks to both the mother and the baby mean that it is essential to take preventative measures and seek medical assistance as soon as possible if a pregnant woman is suspected of being affected with Hepatitis E.

Symptoms of hepatitis E

Hepatitis E can show up in individuals with a variety of symptoms, these symptoms are similar to those of other liver infections. If expectant mothers or their carers know what to watch out for, it can help in recognising the infection early and treating it promptly can reduce all the potential risks to both the mother and baby. 

Some common symptoms of Hepatitis E include:¹ 

• Fatigue, weakness: feeling exhausted, more than normal
• Nausea and vomiting: While nausea and vomiting are common during pregnancy, they are also frequently associated with liver infections like Hepatitis E
• Jaundice: yellowing of the skin and eyes, which is a very common and obvious sign of liver malfunction 
• Dark urine and pale stools: These are also both signs of liver dysfunction 
• Fever and abdominal pain: Fever is a typical sign of infection, and abdominal pain, especially the upper right side of the abdomen, is involved with liver disease as that is where the liver’s biological place is in the body

Pregnant women should be even more careful and aware of these signs and symptoms as early medical intervention is critical in diagnosing Hepatitis E. The potential risks to both the mother and baby can be prevented and treated as early as possible.

If you notice any signs of yellowing of the skin and eyes, excessive tiredness, or changes in stool or urine colour, please seek medical help immediately. 

Diagnosis of hepatitis E

Hepatitis E is diagnosed by doctors via a combination of blood tests and clinical evaluations which help to detect the presence of HEV antibodies in the blood, which is a sign of active or recent HEV infection. Liver function tests are used to measure the levels of liver enzymes, which can be used to assess the seriousness of liver damage.¹ 

Early detection of Hepatitis E can help manage symptoms and reduce complications for both mother and baby, as the virus can cause rapid liver damage in pregnant women.

Treatment options for hepatitis E during pregnancy

At present, there is no specific antiviral medication to treat Hepatitis E. The infection is normally resolved by the body’s immune system, meaning the body can fight it off over time. However, pregnant women need close attention and care if infected, and in some cases, hospitalisation may also be required, especially if the infection is severe.⁶

Supportive measures

However, certain supportive measures can be taken to alleviate symptoms and prevent complications:⁷

• Hospitalisation: In severe cases, admission in the hospital is beneficial as both the mother and baby can be closely monitored, and medical emergencies arising from complications of HEV like preterm birth and excessive bleeding can be resolved by health care specialists
• Hydration and rest: drinking plenty of water and resting completely can allow the body to recover, and slowing down can reduce the burden on the rest of the body so the body can focus on fighting off the infection and also growing and nourishing the baby
• Nutritional support: Eating a well-balanced diet is essential as this can maintain energy and reduce the stress on the liver. Avoiding alcohol consumption is not only essential for the baby’s development but also reduces the stress on the liver

Managing complications

For people assigned female at birth who develop serious complications like liver failure or haemorrhage, more medically intense treatments may be required, for example:⁶

• Monitoring liver function: Regular blood tests can be done to evaluate liver health and avoid the progression to liver failure
• Blood transfusions: In the event of severe bleeding, transfusions (additional blood given) may be required to replenish blood loss and aid the mother's recovery

Preventive measures to avoid hepatitis E

How can pregnant women protect themselves?

As Hepatitis E spreads through contaminated water and food, basic safety measures can be taken to decrease the risk of infection:⁸

• Drinking clean water: If you are unsure about the water's quality, boil it or use a water filter to remove any impurities
• Do not eat raw or undercooked meats/fish: It is advisable to avoid sushi and undercooked meat, especially pork and shellfish, as they are common sources of the Hepatitis E virus
• Maintain good personal hygiene: frequent handwashing with soap, especially after using the bathroom, before handling food, and after coming into contact with potentially contaminated surfaces
• Vaccination: Though no vaccine exists for Hepatitis E, stay updated on vaccinations for other hepatitis viruses (A and B)⁹

Summary

• Hepatitis E is a serious concern during pregnancy due to the increased risks of complications for both the mother and baby
• The most effective way to manage Hepatitis E is through prevention: access to clean water, good hygiene practices, and proper food handling
• Pregnant women should be aware of the symptoms of Hepatitis E and seek medical attention immediately if they suspect infection
• Even though there is no specific treatment for Hepatitis E, supportive care can reduce the risks and lead to a healthier pregnancy and the delivery of a healthy baby