Perinatal Potential Hazards of Hepatitis; a Tertiary Care Study

Aisha Ambreen; Asim  Hussain; Naheed  Bano; Nadia  Afsheen; Muhammad Haseeb Anwar  Tarar; Mazhar  Iqbal

doi:10.51253/pafmj.v74iSUPPL-2.11116

Authors

Aisha Ambreen Department of Biochemistry Punjab medical college, Faisalabad Medical University Pakistan
Asim Hussain KIST School, Korea University of Science and Technology, Seoul, South Korea
Naheed Bano Department of Veterinary & Animal Sciences, Muhammad Nawaz Shareef University of Agriculture, Multan, Pakistan
Nadia Afsheen Department of Biochemistry, Riphah International University, Faisalabad, Pakistan
Muhammad Haseeb Anwar Tarar Department of Biochemistry, University of Agriculture, Faisalabad Pakistan
Mazhar Iqbal Pakistan Health Research Council, Faisalabad Medical University, Faisalabad Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-2.11116

Keywords:

Hepatitis E, hygiene condition & compliance, pregnancy complications, viral transmission, water borne diseases.

Abstract

Objective: To explore the frequency of HEV infection in pregnancy, associated risk factors and its prenatal and maternal consequences.

Study Design: Prospective longitudinal study

Place and Duration of Study: Department of Gynaecology Obstetrics, Divisional Head Quarter Hospital, Multan, Pakistan from Nov 2021 to Jun 2023.

Methodology: The research comprised 100 patients, 50 pregnant patients who met the criteria for eligibility. For seroprevalence, anti-HEV antibodies (IgG) were detected. Hepatic profile, CBC, coagulation markers, and standard workup/protocol were also assessed for prenatal fetomaternal hemorrhage.

Results: Data was gathered using pre-designed questionnaires. Of the 50 patients, 31 (62%), were HEV positive with mean age 26.90±4.16 year. Serum bilirubin levels >1.5 mg/dL in 47 patients (94.00%) with SD1.68±0.28, AST (SD85.87±51.878), ALT (SD149.42±71.90) in 38 (76.00%), low platelet count in 24 cases. There were 6 cases (9.35%) IUD, 3 (8.75%) fetal distress and 4 (12.09%) maternal distress, preterm deliveries 4 (12.09%) and 3(2.5%) neonatal deaths. Mortality rate was (38.7%) 12 cases, due to hepatic comma and intravascular coagulation and Fulminant hepatic failure.

Conclusion: Hepatitis E (HEV) infection during gestation may result in serious consequences such as elevated hepatic profiles, acute anemia, low platelet count, IUD, premature delivery, and postpartum issues, which are primarily caused by inadequate sanitation and a contaminated water source. Maternal fatalities and fetal consequences are exacerbated by HEV infection.

Downloads

Download data is not yet available.

References

Ahmad T, Nasir S, Musa TH, AlRyalat SAS, Khan M, Hui J. Epidemiology, diagnosis, vaccines, and bibliometric analysis of the 100 top-cited studies on Hepatitis E virus. Hum. Vaccin. Immunother. 2021; 17: 857-871.

Al-Shimari FH, Rencken CA, Kirkwood CD, Kumar R, Vannice KS, Stewart BT. Systematic review of global hepatitis E outbreaks to inform response and coordination initiatives. BMC Public Health. 2023; 23: 1120.

Murrison LB, Sherman KE. The enigma of hepatitis E virus. Gastroenterol Hepatol (N Y). 2017; 13: 484.

Lavanchy D. Chronic viral hepatitis as a public health issue in the world. Best practice & research Clinical gastroenterology. 2008; 22: 991-1008.

Perrin HB, Cintas P, Abravanel F, et al. Neurologic disorders in immunocompetent patients with autochthonous acute hepatitis E. Emerging Infect. Dis. 2015; 21: 1928.

Nimgaonkar I, Ding Q, Schwartz RE, Ploss A. Hepatitis E virus: advances and challenges. Nature Reviews Gastroenterology & Hepatology. 2018; 15: 96-110.

Wu C, Wu X, Xia J. Hepatitis E virus infection during pregnancy. Virol J. 2020; 17: 1-11.

Ahmad T, Anjum S, Zaidi N, et al. Frequency of hepatitis E and Hepatitis A virus in water sample collected from Faisalabad, Pakistan. Annals of Agricultural and Environmental Medicine. 2015; 22.

Khuroo M, Kamili S, Khuroo M. Clinical course and duration of viremia in vertically transmitted hepatitis E virus (HEV) infection in babies born to HEV‐infected mothers. Journal of viral hepatitis. 2009; 16: 519-523.

Khuroo MS. Hepatitis E and pregnancy: An unholy alliance unmasked from Kashmir, India. Viruses. 2021; 13: 1329.

Azarkar Z, Sharifzadeh GR, Esfahani MS, Ghanbarzadeh N. Seroprevalence and Risk Factors of Hepatitis E Among Women of Reproductive Age Residing in Birjand in 2016. Modern Care Journal. 2019; 16.

Murad EA, Babiker SM, Gasim GI, Rayis DA, Adam I. Epidemiology of hepatitis B and hepatitis C virus infections in pregnant women in Sana’a, Yemen. BMC Pregnancy Childbirth. 2013; 13: 1-5.

Mansoor M, Raza H, Tariq R. Feto-maternal outcome in HEV infection. Annals of King Edward Medical University. 2011; 17: 86-86.

Vandenbroucke JP, Elm Ev, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann. Intern. Med. 2007; 147: W-163-W-194.

Sultana R, Humayun S. Fetomaternal outcome in acute hepatitis e. J. Coll. Physicians Surg. Pak. 2014; 24: 127-130.

Patra S, Kumar A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Annals of internal medicine. 2007; 147: 28-33.

Kamar N, Bendall RP, Peron JM, et al. Hepatitis E virus and neurologic disorders. Emerging Infect. Dis. 2011; 17: 173.

Tahira K, Junaid K, Ali H, et al. Occupational Health Hazards and Needle Stick Injuries Among Medical Laboratory Workers. Annals of King Edward Medical University. 2020; 26: 391-396.

Kmush BL, Labrique A, Li W, et al. The association of cytokines and micronutrients with hepatitis E virus infection during pregnancy and the postpartum period in rural Bangladesh. The American journal of tropical medicine and hygiene. 2016; 94: 203-211.

Boisson S, Engels D, Gordon BA, et al. Water, sanitation and hygiene for accelerating and sustaining progress on neglected tropical diseases: a new Global Strategy 2015–20. International health. 2016; 8: i19-i21.

Bazerbachi F, Leise MD, Watt KD, Murad MH, Prokop LJ, Haffar S. Systematic review of mixed cryoglobulinemia associated with hepatitis E virus infection: association or causation? Gastroenterology Report. 2017; 5: 178-184.

Fousekis FS, Mitselos IV, Christodoulou DK. Extrahepatic manifestations of hepatitis E virus: An overview. Clinical and molecular hepatology. 2020; 26: 16.

Seth A, Sherman KE. Hepatitis E: what we think we know. Clinical Liver Disease. 2020; 15: S37.

Riveiro‐Barciela M, Bes M, Quer J. Thrombotic thrombocytopenic purpura relapse induced by acute hepatitis E transmitted by cryosupernatant plasma and successfully controlled with ribavirin. Transfusion. 2018; 58: 2501-2505.

Kamar N, Lhomme S, Abravanel F, et al. Treatment of HEV infection in patients with a solid-organ transplant and chronic hepatitis. Viruses. 2016; 8: 222.