Hepatitis E virus infection in pregnancy: A narrative review

Abstract

Hepatitis E virus (HEV) infection is an important cause of acute viral hepatitis worldwide and represents a uniquely severe threat in pregnancy in areas where genotypes 1 and 2 circulate. In low-resource tropical settings, and particularly in the World Health Organization (WHO) Southeast Asia region, HEV infection during pregnancy is associated with disproportionately high maternal case fatality, frequent progression to acute liver failure, and devastating foetal and perinatal outcomes. This narrative review synthesises contemporary evidence on epidemiology, pathogenesis, clinical presentation, maternal and foetal outcomes, management challenges, and prevention strategies with a focus on tropical practice. Critical gaps in diagnostic capacity, access to critical care, and vaccine deployment are highlighted, and practical recommendations are offered to clinicians and health systems working in endemic settings. Strengthened surveillance, outbreak preparedness, inclusion of pregnant women in vaccine policy deliberations, and improved antenatal counselling are essential to reduce preventable deaths from HEV in pregnancy.