Background: Pregnant women are at increased risk of complications in hepatitis E virus (HEV) infection, with the risk increasing as the pregnancy progresses, often leading to fulminant hepatic failure and adverse fetal outcome. Aims: The primary objective of the following study is to evaluate the maternal and fetal complications of this infection and secondary aim is to compare the clinical features of hepatitis E in pregnant women to those in nonâpregnant women. Subjects and Methods: This was a hospital based caseâcontrols study, carried out from July 2008 to June 2010. Over a period of 2 years, cases were serologically confirmed pregnant women with hepatitis E, selected by screening in antenatal clinic. Controls were serologically confirmed nonâpregnant women with hepatitis E, selected by screening in Medicine Outpatient Department. We studied 96 women with HEV infection, of which 52 were pregnant and 44 were nonâpregnant. Clinical and laboratory profile of patients in both groups were studied. Patients were treated as per protocol and the outcome was studied in both groups. Pregnant women were followedâup for fetal and maternal outcome. We used tâtest and zâtest to compare normally distributed data and nonânormally distributed data, respectively. Chiâsquare test was used to compare discrete values between groups. Results:Mean (standard deviation [SD]) age in pregnant patients was 24.1 (3.3) years while 32.6 (10.5) years in nonâpregnant patients. 71.1% (37/52) of the patients were primigravida and 28.8% (15/52) patients were multigravida, by natural occurrence. Mean (SD) gestational age when infection occurred was 27.5 (7.2) weeks. Among pregnant women, 63.4% (33/52) were in 3rd trimester. Jaundice 1â5 days before presentation was seen in 51.9% (27/52) pregnant and 44.2% (23/44) nonâpregnant women. Myalgia/arthralgia, fever, nausea/vomiting, right upper quadrant pain, jaundice, dark urine, lightâcolored stools, pruritus, diarrhea, altered sensorium and hematemesis/melena were presenting features. In pregnant group, 46.1% (24/52) patients developed encephalopathy while in nonâpregnant group 34% (15/44) developed this complication. Among pregnant cases, 67.3% (35/52) survived and 32% (17/52) cases died. In nonâpregnant group, nearly 90% (40/44) patients survived and only 9% (4/44) patients died. This difference was statistically significant (P < 0.01). Adverse fetal outcome was seen in 71.1% (37/52) pregnant women with acute hepatitis E, including preâterm delivery in 23% (12/52), stillbirth in 23% (12/52), abortion in 3.8% (2/52) and intraâuterine fetal death in 21.1% (11/52) patients. Conclusions: There is significantly higher occurrence of hepatitis E infection in pregnant women than in nonâpregnant women, which increases with gestation, with associated fulminant hepatic failure, maternal mortality and worse fetal outcome.