Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed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

Khuroo, M. S. Hepatitis E and Pregnancy: An Unholy Alliance Unmasked from Kashmir, India. Viruses, 2021, 13, 1329. Khuroo, M. S. Hepatitis E and Pregnancy: An Unholy Alliance Unmasked from Kashmir, India. Viruses, 2021, 13, 1329.


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.


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


Medicine and Pharmacology, Immunology and Allergy

Comments (0)

We encourage comments and feedback from a broad range of readers. See criteria for comments and our Diversity statement.

Leave a public comment
Send a private comment to the author(s)
* All users must log in before leaving a comment
Views 0
Downloads 0
Comments 0
Metrics 0

Notify me about updates to this article or when a peer-reviewed version is published.
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here.