Hepatitis E Virus (HEV) causes acute hepatitis and is a hepatotropic pathogenic virus. Due to insufficient sanitation, this infection is endemic in several impoverished nations, especially in India. HEV infection is one of the leading causes of acute viral hepatitis. This disease is mainly spread orally by contaminated drinking water. World Hepatitis Day is observed on 28 July every year, to raise awareness of the problem of viral hepatitis and how viral hepatitis impacts over 354 million people worldwide.
In India, HEV genotype 1 and genotype 2 which is mostly responsible for the cases of viral hepatitis and is feco-orally transmitted. Viral hepatitis has been a major public health problem in India. HEV infection is responsible for most of the pandemics that have occurred in India and is responsible for 30% to 70% of the sporadic cases of viral hepatitis and the major cause of acute liver failure. It has been observed that viral hepatitis is the most common cause of jaundice during pregnancy and causes HEV infection. Classically acute viral hepatitis occurs during the second and third trimesters of manifesting with malaise and jaundice.
It is not clear why HEV infection has a predilection to occur specifically during pregnancy. Severity had been attributed to the variable immune response or hormonal factors. Many patients are contemplating whether the occurrence of viral hepatitis has a safe course during pregnancy. Most of the patients with viral hepatitis during pregnancy will recover within four to six weeks of the onset of jaundice. However, these patients need to be instructed that they should continue to be under the supervision of physicians and gynaecologists till jaundice settles down clinically and biochemically.
The liver function tests and serological tests (IgM anti-HEV) are the key tools for the diagnosis. In India, HEV infections (genotype 1 and 2) have a fulminant course during pregnancy compared to developed countries where genotypes 3 and 4 are believed to have mild disease. The follow up of the cases during pregnancy is needed to detect complications like acute liver failure, stillbirth and eclampsia, postpartum haemorrhage. Those cases of viral hepatitis during pregnancy that have a severe downhill course, the outcome is associated with premature delivery, stillbirth and abortions.
If there is any indication that the patient has persistent vomiting and altered mental status, it indicates the possibility of acute liver failure and the patient needs immediate hospitalisation and with intensive care, they may recover.
In such a situation the physician and the patient should understand that the termination of the pregnancy does not alter the course of the disease. Early liver transplant has been carried out in some centres even for patients of ALF during pregnancy. This is also possible in some of the centres involved in liver transplantations in India. All patients with viral hepatitis during pregnancy should be advised to have hospital delivery. In conclusion, though viral hepatitis cases during pregnancy may have a safe course, yet it needs close monitoring to detect complications that could be effectively treated.
The writer is a Senior Director & HOD – Gastroenterology, Max Super Speciality Hospital, Vaishali.