Historical Analysis of the Risk of Hepatitis E and Its Complications in Pregnant Women in Nepal, 1996-1998

Abstract

Hepatitis E (HE) during pregnancy can be fatal; there are no prospective risk estimates for HE and its complications during pregnancy. We followed 2,404 pregnant women for HE and pregnancy outcomes from 1996 to 1998. Subjects from Nepal were enrolled at an antenatal clinic with pregnancy of ≤ 24 weeks. Most women (65.1%) were anti-HE virus negative. There were 16 cases of HE (6.7 per 1,000); three mothers died (18.8%) having had intrauterine fetal death (IUFD). Thirteen mothers survived: five preterm and seven full-term deliveries, one IUFD. HE among seronegative women was the sole cause of maternal death and increased the risk of IUFD (relative risk [RR]: 10.6; 95% confidence interval [CI]: 4.29-26.3) and preterm delivery (RR: 17.1, 95% CI 7.56-38.5). HE vaccination of females in at-risk regions before or as they attain reproductive age would reduce their risk for preterm delivery, IUFD, and maternal death.

Conflict of interest statement

Disclaimer: The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Defense.

Disclosure: BLI reports employment by GSK 1999 to Jan 2017.

Figures

Figure 1.

Cohort of pregnant women followed for HE in Kathmandu, Nepal, 1996–1998.

Figure 2.

Age-specific prevalence of anti-HEV pregnant women in the per-protocol cohort in Kathmandu, Nepal, 1996–1998 (n = 2,401, three seropositive women ≥ 40 years of age were excluded).

Figure 3.

Timing of jaundice admissions to sentinel hospitals (N = 2,399) (line plot) and of HE onset in the per-protocol cohort (N = 15, one HE with unknown onset was excluded) (vertical bars) in Kathmandu, Nepal, 1996–1998.