Fetal and Neonatal Health Consequences of Vertically Transmitted Hepatitis E Virus Infection

Abstract

Abstract. Hepatitis E virus (HEV) infections lead to tens of thousands of deaths annually, mostly in developing countries. Hepatitis E poses a significant threat to the health of expectant mothers, a well-noted epidemiologic feature of the disease, but the contribution of vertically transmitted HEV infection to fetal and neonatal morbidity and mortality has received limited attention. Evidence assembled to date suggests that mother-to-child HEV transmission may be frequent and deleterious to the fetus and newborn in pregnancies affected by hepatitis E. Additional work is required to resolve key questions. (1) What risks do subclinical maternal HEV infections and infections early in pregnancy pose to fetal health and development? (2) Does vertical transmission occur during labor and/or breastfeeding and contribute appreciably to neonatal morbidity and mortality? (3) How do treatment decisions for severely ill mothers affect fetal and neonatal outcomes? (4) Can maternal vaccination effectively prevent vertical transmission of HEV?

Host Immune Status and Response to Hepatitis E Virus Infection

“…Vertical transmission appears to be common among mothers with symptomatic hepatitis E, with deleterious effects on fetal and neonatal health (334,336,337). Because few studies have addressed the issue, it is unclear to what extent the fetuses and neonates of women with subclinical or asymptomatic infection are at risk (370). There are not yet any reliable data on whether HEV is transmissible via breast milk.…”

Prevention and Management of Viral Hepatitis in Pregnancy

“…Transmission can also occur through blood transfusions and solid organ donations. Perinatal transmission of HEV during acute infection has been documented, 88 and the risk of transmission can be as high as 79%. 89 However, this estimate is limited by small case series, limited surveillance, and underdiagnosis of HEV during pregnancy.…”

HEV infection in two referral centers in Spain; epidemiology and clinical outcomes

“…The infection was cleared successfully in the latter case, although acute infection by HEV genotypes 1-2 during pregnancy has been associated with a worse outcome in developing countries [18].…”