{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:29:29Z","timestamp":1790022569319,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E\u2010related deaths were among pregnant and postpartum women, we analysed maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and assessed whether HIV\u2010status impacted on outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cross\u2010sectional study was performed at Windhoek Hospital Complex. Pregnant and postpartum women, admitted between 13 October 2017 and 31 May 2019 with reactive IgM for Hepatitis E, were included. Outcomes were acute liver failure (ALF), maternal death, miscarriage, intra\u2010uterine fetal death and neonatal death. Odds ratios (OR) and 95% confidence interval (CI) were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy women were included. ALF occurred in 28 (40.0%) of whom 13 died amounting to a case fatality rate of 18.6%. Sixteen women (22.9%) were HIV infected, compared to 16.8% among the general pregnant population (OR 1.47, 95% CI 0.84\u20102.57, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.17). ALF occurred in 4\/5 (80%) HIV infected women not adherent to antiretroviral therapy compared to 1\/8 (12.5%) women adherent to antiretroviral therapy (OR 28.0, 95% CI 1.4\u2010580.6). There were 10 miscarriages (14.3%), five intra\u2010uterine fetal deaths (7.1%) and four neonatal deaths (5.7%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>One in five pregnant women with Hepatitis E genotype 2 died, which is comparable to genotype 1 outbreaks. Despite small numbers, HIV infected women receiving antiretroviral therapy appear to be less likely to develop ALF in contrast with HIV infected women not on treatment. As there is currently no curative treatment, this phenomenon needs to be assessed in larger cohorts.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15076","type":"journal-article","created":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T09:29:04Z","timestamp":1633771744000},"page":"50-58","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and the impact of HIV status: A cross\u2010sectional study in Namibia"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1172-4237","authenticated-orcid":false,"given":"Steffie","family":"Heemelaar","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Katutura State Hospital Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L.","family":"Hangula","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Katutura State Hospital Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5776-9599","authenticated-orcid":false,"given":"Melody L.","family":"Chipeio","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Katutura State Hospital Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3526-0788","authenticated-orcid":false,"given":"Mirjam","family":"Josef","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Katutura State Hospital Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2732-6620","authenticated-orcid":false,"given":"Jelle","family":"Stekelenburg","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Global Health Unit University Medical Center Groningen Groningen The Netherlands"},{"name":"Department of Obstetrics and Gynaecology Medical Center Leeuwarden Leeuwarden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H.","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Leiden University Medical Center Leiden The Netherlands"},{"name":"Faculty of Science VU University Athena Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3370-3274","authenticated-orcid":false,"given":"Sven","family":"Pischke","sequence":"additional","affiliation":[{"name":"Department of Medicine University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shonag B. P.","family":"Mackenzie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Katutura State Hospital Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25505"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13237"},{"key":"e_1_2_12_4_1","volume-title":"The Global Prevalence of Hepatitis E Virus Infection and Susceptibility: A Systematic Review","author":"World Health Organization"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61849-7"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268816000418"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.1929"},{"key":"e_1_2_12_8_1","first-page":"185","article-title":"Hepatitis E vaccine: WHO position paper, May 2015","volume":"90","author":"World Health Organization","year":"2015","journal-title":"Wkly Epidemiol Rec"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviromet.2019.04.017"},{"key":"e_1_2_12_10_1","volume-title":"Outbreak of Hepatitis E Virus (HEV) in Namibia, Situation Report (SITREP No. 64)","author":"Ministry of Health and Social Services"},{"key":"e_1_2_12_11_1","volume-title":"Report on the Confidential Enquiry into Maternal Deaths 1 April 2018 to 31 March 2019 and Near Miss 1 October 2018 to 31 March 2019","author":"National Maternal Death, Near Miss, Stillbirth and Neonatal Death Review Committee"},{"key":"e_1_2_12_12_1","volume-title":"Namibia Population\u2010Based HIV Impact Assessment NAMPHIA 2017","author":"Ministry of Health and Social Services","year":"2018"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2016.05.006"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00062-13"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2000.62.619"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1099\/vir.0.19587-0"},{"key":"e_1_2_12_17_1","volume-title":". 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