title: Case-fatality risk of pregnant women with acute viral hepatitis type E: a systematic review and meta-analysis.
abstract: It is of great concern that pregnant women with acute viral hepatitis (AVH) type E have serious consequences. This study aimed to estimate the case-fatality risk (CFR) and potential risk factors of pregnant women with AVH type E. We searched the PubMed, EMBASE, and Web of Science databases for studies containing data on CFR in pregnancy with AVH type E. A pooled estimate of CFR was calculated using a random-effects model. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. We identified 47 eligible studies with a total African and Asian population of 3968 individuals. The pooled CFRs of maternal and fetal outcomes were 20·8% [95% confidence interval (CI) 16·6-25·3] and 34·2% (95% CI 26·0-43·0), respectively. Compared with these, the pooled CFR was highest (61·2%) in women with fulminant hepatic failure (FHF). Community-based surveys had lower pooled CFR (12·2%, 95% CI 9·2-15·6) and heterogeneity (25·8%, 95% CI 20·1-32·0) than hospital-based surveys. Univariate analysis showed that hospital-based surveying (P = 0·007), and patients in the third trimester of pregnancy or with FHF (P < 0·05), were significantly associated with CFR. Intrauterine fetal mortality (27·0%) was statistically higher than neonatal mortality (3·9%). Control measures for HEV infection would reduce feto-maternal mortality in Asia and Africa.
authors.affiliation: Department of Epidemiology and Health Statistics,School of Public Health,Southeast University,Nanjing,China.
authors.forename: H
authors.initials: H
authors.lastname: Jin
authors.affiliation: Key Laboratory of Environmental Medicine Engineering,Ministry of Education,School of Public Health,Southeast University,Nanjing,China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Jiangsu Provincial Center for Disease Control and Prevention,China.
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Jiangsu Provincial Center for Disease Control and Prevention,China.
authors.forename: B
authors.initials: B
authors.lastname: Wang
authors.affiliation: Key Laboratory of Environmental Medicine Engineering,Ministry of Education,School of Public Health,Southeast University,Nanjing,China.
authors.forename: P
authors.initials: P
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D016751:Hepatitis E / Q000401:mortality* / Q000821:virology; D016752:Hepatitis E virus / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000401:mortality* / Q000821:virology; D012307:Risk Factors; D055815:Young Adult
keywords: Acute viral hepatitis E; case-fatality risk; meta-analysis; pregnancy