Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Hepatitis E and Pregnancy: An Unholy Alliance

Version 1 : Received: 12 May 2021 / Approved: 13 May 2021 / Online: 13 May 2021 (13:52:29 CEST)

A peer-reviewed article of this Preprint also exists.

Journal reference: Viruses 2021
DOI: 10.3390/v13071329

Abstract

The adverse relationship between viral hepatitis and pregnancy in developing countries was seen as a reflection of retrospective biased hospital-based data collection by the West. However, the discovery of HEV from an epidemic of non-A, non-B hepatitis in Kashmir and documenting increased incidence and severity of hepatitis E in pregnancy from a house-to-house survey unmasked the unholy alliance. Among the family of HEV’s, genotype (gt)-1, with a unique ORF4-encoded protein enhancing viral polymerase activity and viral replication, is the sole HEV that shows this adverse relationship. The epidemics caused by HEV-gt1 and not by HEV-gt2 show adverse relationship with pregnancy. The pathogenesis of the unholy alliance is complex and at present not well understood. Possibly multiple factors play a role in causing severe liver disease in the mother including: infection, replication and damage to the maternal-foetal interface by HEV-gt1; vertical transmission of HEV to foetus causing severe foetal/neonatal hepatitis; and combined viral and hormone related immune dysfunction of diverse nature in the mother promoting viral replication. Management is multidisciplinary and needs a close watch for the development and management of ALF. Preliminary data suggest beneficial maternal outcomes by early termination of pregnancy in patients with lower grades of encephalopathy.

Keywords

Hepatitis E virus; Genotype; Epidemic hepatitis; Sporadic hepatitis; Pregnancy; Foetus; Neonate; Vaccine

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