Introduction
Hepatitis E, also known as viral liver infection (VHL), is caused by the Hepatitis E Virus (HEV). It is transmitted primarily through contaminated water and food. Pregnant women are at a higher risk for complications. These include severe liver damage, liver failure and maternal or infant mortality. This infection can be particularly dangerous in the 3rd trimester where mortality rates can reach 20-30%.
This blog discusses Hepatitis E and its impact on pregnancy. It includes symptoms, complications, risks, diagnostic options, treatment, and prevention measures.
Hepatitis E Virus Infection During Pregnancy
Hepatitis E can be caused by HEV. HEV has four genotypes:
1. Genotypes 1, 2 :- Human specific, commonly causing outbreaks of disease in developing countries.
2. Genotypes 3, 4, and 5 :- They are found in animals such as pigs and deer. They can infect humans through the consumption of undercooked meat, particularly in industrialized countries.
Genotype 1 is the greatest threat to pregnant women in areas like India, Africa and Southeast Asia.
Hepatitis E symptoms during pregnancy
Hepatitis E symptoms are similar to other viral hepatitis. In pregnant women, symptoms may be more severe or prolonged. Symptoms include:
1. Jaundice :- Yellowing of skin and eyes caused by liver dysfunction.
2. Extreme Fatigue :- Severe fatigue and weakness.
3. Abdominal pain :- Pain or discomfort in the upper right abdominal area.
4. Vomiting and Nausea :- Consistent vomiting that can cause dehydration.
5. Loss Of Appetite :- Reduced desire to consume food, leading to potential weight loss.
6. Fever :- Mild or moderate fever at the beginning stages.
7. Dark Urine & Pale Stools :- Sign of impaired liver function.
8. Abdominal Swelling :- It Caused by liver dysfunction and fluid buildup.
In severe cases the infection can quickly progress to acute liver dysfunction putting the mother as well as the fetus in danger.
Why does Hepatitis E become more severe during pregnancy?
Pregnant woman’s immune and physiological systems undergo changes, which can increase their vulnerability to infection. Hepatitis E is more severe in pregnant women for the following reasons:
1. Weakened immune response :- Pregnancy changes the immune function and makes it more difficult to fight viruses.
2. Hormonal changes :- Estrogen fluctuations and progesterone fluctuation can affect liver function, increasing susceptibility.
3. Liver stress :- The liver already works harder during pregnancy making it more susceptible to viral infections.
5. Increased viral load :- Studies have shown that pregnant women carry an increased viral load which can lead to severe disease progression.
Hepatitis-E and Pregnancy
Hepatitis E during pregnancy can lead to a number of life-threatening complications including:
1. Acute Liver Failure (ALF) :- Hepatitis E may cause full-blown hepatic insufficiency where the liver stops working suddenly. This condition is serious and requires immediate medical attention. It can be fatal in pregnant women.
2. High Maternal Mortality Rate :- Third-Trimester Infections have a mortality rate of 20-30%. Hepatitis is one of the most deadly viral infections in pregnant women.
3. Preterm labor and miscarriage :- Hepatitis-E infection can cause preterm labour, or spontaneous miscarriages. This increases the risks to both mother and child.
4. Stillbirths and Neonatal Mortality :- Hepatitis-E infection can cause fetal discomfort, stillbirths and neonatal deaths. This is especially true if a mother has liver failure.
5. Postpartum Hemorrhage (PPH) :- Hepatitis-E can cause severe bleeding after birth if the condition is not treated promptly.
Diagnosis Hepatitis E In Pregnant Women
Accurate diagnosis is important because symptoms of Hepatitis E can mimic those of other liver infections. Doctors may prescribe:
1. Liver function tests (LFTs) :- Elevated liver enzymes indicate liver inflammation.
2. Serology tests :- Detects IgM or IgG anti-HIV antibodies.
3. HEV DNA PCR Test :- Confirms viral infection by detecting genetic material.
4. Ultrasound Imaging :- It Can be used to assess liver health and fetal wellbeing.
Early detection of the infection is crucial to preventing complications and managing it.
Treatment of Hepatitis E in Pregnancy
There is currently no antiviral treatment available for Hepatitis E. The focus of management is on supportive care in order to alleviate symptoms and prevent complications. Treatment options include:
1. Hospitalization is recommended for severe cases :- Often, pregnant women who have severe liver disease or symptoms of infection are admitted to hospital for closer monitoring.
2. Fluid and Electrolyte Replace :- In order to prevent dehydration due to nausea and vomiting, intravenous fluids are often required.
3. Nutritional Support :- To support liver recovery, a balanced diet high in protein is recommended. Avoid processed foods and fatty food.
4. Medications to relieve symptoms :- The doctor may prescribe medication for nausea, fever, or pain.
5. In extreme cases, liver transplantation may be necessary :- A liver-transplant is the only option for women with acute liver failure.
Preventing Hepatitis E During Pregnancy
Women who are pregnant, especially those who live in high-risk areas or travel to them, should take preventive measures. The following are key prevention strategies:
1. Drink Safe Water :- Purify or boil water before consuming. In areas where sanitation is poor, avoid tap water and ice.
2. Maintain Proper Hygiene :- Hands should be washed frequently with soap or clean water. Surfaces and cooking implements should be cleaned properly.
3. Eat Hygienic, Well-Cooked Food :- Avoid street foods and meats that are raw or undercooked. Before consumption, wash fruits and vegetables thoroughly.
4. Improve Your Sanitation Practices :- Avoid open defecation and use proper toilets. Avoid water contamination by disposing of waste correctly.
5. Future prospects of vaccination :- Hepatitis-E vaccines may be available in certain countries but are not widely available. Researchers continue to investigate the use of vaccines for high-risk populations, including pregnant women.
Conclusion
Hepatitis-E virus infection is a serious risk for pregnant women. It can lead to complications such as acute liver disease, maternal death and fetal loss. prevention is the best strategy, given the lack of a specific treatment. This includes proper hygiene, drinking safe water and sanitation. Women who are pregnant in high-risk areas should take extra precautions, and seek medical attention immediately if symptoms occur.
We can protect the health of mothers and babies by increasing awareness and improving sanitation.
