(1175) Pregnancy outcomes in hepatitis E-associated hospitalizations in the United States: a nationwide study

Hepatitis E virus (HEV) is typically asymptomatic in developed countries but can be severe in certain populations including pregnancy. However, in the U.S. there is limited data on the effects of the endemic genotype of HEV on the pregnant population, thus, we aim to investigate a large cohort of pregnant women and describe the characteristics and pregnancy outcomes in those with HEV from 1998-2020.

Study Design: We utilized the National Inpatient Sample and extracted cases of HEV-associated hospitalizations using ICD-9/10 diagnostic codes. Demographic, clinical, and pregnancy data were extracted and analyzed by chi-square.

Results: We identified 3,354 cases of HEV-associated hospitalizations, among those, 226 (6.7%) involved pregnant women. The median age was 30 years compared to 28 years in the non-HEV pregnant cohort (p=0.021). The race/ethnic distribution was 35.0% non-Hispanic White, 15.0% non-Hispanic Black, 10.6% Hispanic, 13.3% Asian/Pacific Islander. There were no cases of maternal death in the HEV pregnant cohort. Diabetes was found to be more common in the HEV pregnant cohort, 6.2% versus 1.1% (p< 0.001). Additionally, hepatitis B co-infection (31.9% vs 0.1%, p< 0.001), hepatitis C co-infection (11.1% vs 0.3%, p< 0.001), intravenous drug use (6.6% vs 0.6%, p< 0.001), coagulopathy (4.0% vs 0.3%, p< 0.001), and thrombocytopenia (6.2% vs 0.9%, p< 0.001) were significantly more common in the HEV pregnant cohort compared to the non-HEV pregnant cohort. Fetal heart rate/rhythm abnormalities were more frequent in the HEV pregnant cohort, 24.3% versus 12.4% (p=0.015). There were no differences in frequency of obesity, HIV infection, and pre-eclampsia (p >0.05). Among the 226 HEV pregnancies, 172 (76.1%) were hospitalized for delivery. There were no cases of stillbirth, and the frequencies of preterm and post-term births were similar to non-HEV pregnant cohort.

Conclusion: Among U.S. pregnant patients with hepatitis E, co-morbidities such as co-infection with other hepatitis viruses were more common, but maternal and fetal outcomes were favorable and similar to the non-HEV pregnant population.