Hepatitis E among Women Who Have Had Abortions, Risk Factors and Effects on Pregnancy.

Introduction

Hepatitis E (HEV) infection is a risk factor in pregnancy and causes a high mortality rate by fulminant hepatic failure (0%-20%), particularly in the third trimester. The prevalence of anti HEV in Saudi Arabia is estimated at 8%-9%. There has been no report on the association between anti HEV and abortion in Saudi Arabia, so further investigation was required. A study was conducted on pregnant women and women who have had abortions and were admitted to Maternity and Children's Hospital (MCH) to determine if there is an association between Hepatitis E (HEV) and abortion, and to identify the risk factors for having anti HEV among the positive cases in both women who have had abortions (cases) and pregnant women (controls).

Methodology

The study was conducted in MCH from the 1st of Moharram to the 15th of Safar 1416 H. The information was collected from medical charts on admission, from medical files transferred with the patient from primary health care centers and by interviewing the women on arrival to the hospital. Blood samples were collected from each subject on admission. The case group was limited to women of up to 22 weeks of gestation and all healthy pregnant women who were over 24 weeks of gestation and attending the antenatal clinic during the study period.

Results

Among 204 subjects, there were 102 women with abortions and 102 pregnant women. The median age was 31 years, ranging from 15 to 46. 141(70%) were Saudi and 63(30%) were non-Saudi. There were 22 cases of anti HEV among the case-group and 9 among the control-group (OR=2.8, 95% CI=1.15-7.16, p-value = 0.01). There was an association between having one abortion or more and having anti HEV (OR=8, 95% CI=1.5-58, p-value=0.002), (Summ OR=3, 95% CI=1.4-8). Use of an IUCD as contraceptive and use of traditional medicine were significant risk factors (OR=3.3, 95% CI=1.2-9, p-value=0.007 and OR=3, 95% CI=1.5-5, p-value=0.0003, respectively). The following risk factors are significant and associated with having anti HEV: drinking water from jerrycans (Summ OR=7.6, 95% CI=3-18) and reporting having insects in houses (Summ OR= 4.9, 95% CI =1.8-9.3). However, having a servant in the house was protective (Summ OR=0.2, 95% CI=0.08-0.05).

Conclusion

This report is the first to describe the prevalence of anti-bodies against HEV and its effects on pregnant women in Saudi Arabia. Our findings indicate that anti HEV is significantly higher in women who have had abortions than in pregnant women. Positive cases in this study were free from other causes of abortion, such as rubella or toxoplasmosis. We could not confirm whether these cases were infected recently or in the past. Hepatitis E IgM is not yet commercially available and is still under trial. It was concluded from this study that having anti HEV is related to the level of hygiene and the availability of good drinking water.