Hepatitis E virus (HEV) infection, an enterically transmitted viral disease, was found to be endemic in Egypt. However, no outbreaks or epidemics have ever been reported. This study, a prospective cohort study, was conducted in three rural villages in Menoufia to assess the magnitude of HEV infection among pregnant women and their offspring. At the time of study enrollment, anti-HEV seroprevalence was found to be as high as 84.3% among 2428 pregnant women. Several risk factors associated with anti-HEV included older age, not using soap to wash fruits and vegetables, frequent contact with cats, exclusive residence within the study area and residence in Melieg (one of the three study villages). Histories of jaundice (1.4%) and liver disease (0.7%) were rare and not increased in those having anti-HEV. Sixteen seroconversions were observed among the 295 baseline anti-HEV IgG negative women who were subjected to follow up for about 1 year, giving an estimated anti-HEV seroincidence rate of 49.25 per 1000 person years. Risk factors associated with the seroincident cases were residence in Melieg, having history of previous miscarriage and frequent contact with dogs. None of the new cases gave history of any associated manifestations such as jaundice, change in colour of urine or any constitutional manifestations. All the 16 seroconverters were suspected to have converted during pregnancy, yet no adverse pregnancy outcome was observed among them. Until the age of one year, none of the infants born to the study cohort acquired the infection. It was concluded that HEV infection is wide spread in the studied Egyptian villages. However, no disease morbidity or complications were observed in the studied population, and no evidence of childhood infection was detected through first year of life.