Maternal hepatitis E virus infection: Immunopathogenesis, genotype-specific severity, and vertical transmission dynamics

Table 2 Maternal, fetal, and neonatal outcomes associated with hepatitis E virus infection during pregnancy

Outcome category	Clinical outcome	Reported risk/findings	Key determinants
Maternal	Fulminant hepatic failure	Leading cause of death	HEV-1 infection, 3rd trimester
	Maternal mortality	15%-30% (endemic regions)	Viral load, delayed care
	Disseminated intravascular coagulation	Common complication of FHF	Hepatic failure + bleeding + hypercoagulability
	Liver dysfunction	ALT > 1000 IU/L, coagulopathy	Cytokine storm, viral replication
Fetal	Intrauterine fetal demise	High frequency	Maternal instability, placental damage
	Stillbirth	Increased risk (OR approximately 2.6)	Severe maternal disease
	Preterm birth	OR approximately 3.4	Placental dysfunction
	Low birth weight	OR approximately 3.2	Maternal illness, inflammation
	IUGR	Increased risk	Placental insufficiency
Neonatal	Vertical transmission	36.9% (range from 33%-100%)	Maternal viral load
	Neonatal mortality	Approximately 8% (median)	Severe maternal disease
	Acute hepatitis	Common	Viral replication
	Coagulopathy	Severe cases	Liver dysfunction
	Prognosis	Self-limited if survives	Viral clearance in weeks-months

HEV: Hepatitis E virus; IUGR: Intrauterine growth restriction; FHF: Fulminant hepatic failure; ALT: Alanine aminotransferase; OR: Odds ratio.