Viral hepatitis in pregnancy: integrating clinical management, perinatal outcomes, and long-term health impact

BACKGROUND: Viral hepatitis during pregnancy represents a heterogeneous group of infections with distinct virological, immunological, and clinical characteristics, resulting in variable maternal and fetal outcomes. Hepatotropic viruses and non-hepatotropic agents may affect the liver during pregnancy, with clinical presentations ranging from asymptomatic conditions to severe complications such as acute liver failure. METHODS: This manuscript was conducted as a narrative review aimed at providing a comprehensive and clinically oriented overview of viral hepatitis during pregnancy, including epidemiology, virology, immunology, maternal and fetal outcomes, vertical transmission, screening strategies, prevention, and clinical management. A literature search was performed using the PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases focusing primarily on articles published between January 2000 and June 2026. RESULTS: While hepatitis A generally follows a self-limited course, hepatitis B and C are frequently associated with chronic infection and risk of vertical transmission, and hepatitis E is notably linked to increased maternal morbidity and mortality, particularly in the third trimester. Vertical transmission is a central concern, especially for hepatitis B and C, being strongly influenced by maternal viral load, serological status, and obstetric factors. In hepatitis B, perinatal transmission remains a major route of infection, with high rates of chronicity in neonates. In hepatitis C, transmission rates are lower but clinically relevant, particularly in the presence of sexually transmitted coinfections. In contrast, hepatitis E is associated with severe maternal disease and adverse perinatal outcomes, including fetal death and prematurity. CONCLUSION: Diagnosis relies on clinical suspicion, laboratory evaluation, and specific serological and molecular tests, while screening strategies during prenatal care play a crucial role in early identification and risk stratification. Preventive measures, including vaccination, antiviral therapy, and neonatal immunoprophylaxis, are essential to reduce vertical transmission and improve outcomes. Despite advances, important gaps remain in understanding pathophysiology, optimizing treatment during pregnancy, and ensuring equitable access to care. A comprehensive approach is fundamental to reducing the burden of viral hepatitis in maternal and neonatal health.