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Jaundice (High Bilirubin) In Pregnancy: Causes, Symptoms, And Treatment

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Liver disorders are not so common during pregnancy. But when a liver disease does happen, it can affect both the mother and the fetus. Such cases are considered to complicate up to 3% of all pregnancies (1).

Jaundice is one of the several symptoms of liver disorder. Pregnant women could be affected by jaundice, which can sometimes be directly or indirectly associated with pregnancy. Keep reading this MomJunctionpost to know about the causes of jaundice in pregnancy, its symptoms, possible complications,and treatment.

How Common Is Jaundice In Pregnancy?

Jaundice in pregnancy is relatively rare, occurring in one out of 1,500 pregnancies, which is an incidence rate of 0.067% (2).

It has been reported that abnormal liver tests do appear in 3%—5% of pregnancies (3). But these are not always jaundice, and most abnormalities in the liver are often associated with the state of pregnancy itself.

What Are The Symptoms Of High Billirubin During Pregnancy?

Signs and symptoms of jaundice may vary depending on the underlying condition (infection or liver disease). Some of the general symptoms of jaundice in pregnancy are (4):

  • Fever
  • Chills
  • Abdominal pain
  • Yellowing of skin and white portion in the eyes, what we are calling jaundice.
  • Dark-colored urine
  • Light or clay-colored stools
  • Weight loss
  • Itchy skin (pruritus)

What Are The Causes Of Jaundice In Pregnancy?

The fundamental cause of jaundice is the presence of excess bilirubin (a yellow-orange pigment) in the body. Bilirubin is a natural compound produced in the body and processed by the liver. The presence of high levels of bilirubin in the body suggests something wrong with the liver.

According to experts, jaundice in pregnancy can occur in any of the three trimesters. It may result from the conditions that are either associated with the pregnancy or unrelated to it (1).

Pregnancy-specific conditions that can cause jaundice are:

  • Preeclampsia (second or third trimester): This condition affects 5—10% of all pregnancies. Affected women have high blood pressure, edema, and proteinuria ( high amount of protein in the urine) (3).
  • HELLP syndrome (second or third trimester): The hemolysis (H), elevated liver tests (EL), and low platelet count (LP) (HELLP) syndrome occurs in one out of 1,000 pregnancies. A severe form of preeclampsia, it is characterized by vomiting, nausea, edema, weight gain, abdominal pain, proteinuria, hypertension, fatigue, and jaundice (3).
  • Hyperemesis gravidarum (first trimester): This condition affects about 0.3% of pregnant women. It is characterized by severe nausea and vomiting that may lead to weight loss, electrolyte imbalance, disturbed nutrition, and jaundice (3) (5).
  • Intrahepatic cholestasis of pregnancy (second or third trimester): This condition is rare but can increase the risk of fetal mortality. It causes severe itching (pruritus) in expecting mothers. Often, women also develop symptoms of jaundice, such as yellowing of skin and eyes (1) (6). Around 20% of the patients develop jaundice and pruritus.
  • Dubin-Johnson syndrome (second or third trimester): It is a genetic disorder that is characterized by recurring jaundice. Usually, jaundice worsens during pregnancy due to this condition (7).
  • Acute fatty liver of pregnancy (third trimester): Although rare, it is characterized by jaundice, nausea, vomiting, headache, abdominal pain, anorexia, ascites, hypertension (high blood pressure), and edema (swelling) (3). The condition could be fatal.

Other conditions that can cause jaundice, but are unrelated or not associated with pregnancy are:

  • Acute viral hepatitis: It is the most common cause of non-pregnancy jaundice. Acute hepatitis A occurs in one out of 1,000 pregnancies, and acute hepatitis B occurs in two out of 1,000 pregnancies. There is also a possibility of hepatitis C,but hepatitis D is rare (1) (3). Hepatitis E can be life-threatening.
  • Gallstones in the common bile duct (Choledocholithiasis): This condition occurs when a gallstone blocks the common bile duct. Around 7% of women with jaundice in pregnancy have this condition (8).
  • Drug-induced toxicity (hepatotoxicity): Excess dosage ofa few drugs such as acetaminophen can induce toxicity in the liver, thus causing jaundice.
  • Worsening of underlying chronic liver disease: Expecting mothers with chronic liver diseases such as chronic hepatitis, autoimmune disease, Wilson’s disease, and primary biliary cirrhosis may experience complications that may require regular screening(1).

What Are The Possible Risks And Complications?

Depending on the cause of jaundice in pregnancy, the complications may vary for both the mother and the baby (1) (3).

  • Premature labor
  • Abruptio placentae (premature separation of the placenta from the uterus)
  • Placental insufficiency (placenta is unable to deliver necessary nutrients and oxygen to the developing fetus)
  • Renal or hepatic failure
  • Hepatic rupture, also called hepatic hemorrhage
  • Perinatal or fetal death
  • Postpartum hemorrhage
  • Variceal bleeding, which is the bleeding from ruptured blood vessels (a major risk factor for patients with cirrhosis)
  • Hepatic encephalopathy (decline in brain function due to severe liver disease)
  • Fulminant viral hepatitis (sudden and acute liver failure)

If you have chronic liver disease or have experienced any unusual symptoms, consult your healthcare practitioner for early diagnosis and better management of your underlying condition.

Diagnosis Of Jaundice In Pregnancy

Healthcare practitioners diagnose jaundice by identifying signs and symptoms for liver diseases. They may check for the presence of the following (4).

  • Yellow discoloration of the skin and the sclera (white of the eye)
  • Appearance of red coloration and bruises on the skin of palms and fingers
  • Presence of abnormal collection of blood vessels near the skin surface (also known as spider angiomas)
  • Bilirubin levels in the blood and urine
  • Hepatitis viral test to determine the presence of hepatitis infection
  • Liver enzyme tests to determine the levels of liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) through a blood test
  • Ultrasound imaging to check the size of the liver

In rare cases, the doctor might suggest a liver biopsy. The above tests are usually sufficient to determine the cause of jaundice in pregnancy.

Treatment Of Jaundice In Pregnancy

Jaundice in adults does not require any treatment, and the condition cures by itself. The doctor may recommend management techniques and, in a few cases, medication when the risk of jaundice is severe enough to affect the mother or the fetus. Here are some measures taken to manage jaundice during pregnancy (3).

  • Bed rest and intravenous fluids.
  • Providing the mother with supplements that help in ensuring that the growing fetus gets sufficient nutrition.
  • Balanced nutritious diet that can help immune system fight viruses better.
  • Stabilizing the blood pressure through hospitalization and medication.
  • Laparoscopic surgery might be required in the cases of jaundice caused by blocked bile ducts.

Foods To Eat And Foods To Avoid

During jaundice, you might have to avoid foods that could strain the liver and slow down its repair. In addition to the dietary recommendations made by your doctor, you may follow some general guidelines for jaundice in pregnancy (9).

  • You could add five portions of fruits and vegetables in your diet. These are excellent sources of fiber, minerals, and vitamins. Some fruits and vegetables might not be suitable for consumption during pregnancy. Therefore, consult a doctor to know more.
  • Include whole grains like oatmeal and brown rice in your diet. You can also have lean protein from meat.
  • Opt for food items that are low in saturated fat and prefer unsaturated fat. Check the food labels for the presence of these fats.
  • Avoid packaged or canned food items that have added refined sugars, saturated fats, and high sodium levels.
  • In the case of viral hepatitis infection (Hepatitis A), you may continue with a regular healthy diet. You might need nutritional supplements to help the body cope with the illness and to manage any sudden weight loss.

Do oranges cause jaundice during pregnancy?

No correlation or association has been found between the consumption of oranges and jaundice in pregnancy. They are an excellent source of vitamin C, which is required during pregnancy.

How To Prevent Jaundice During Pregnancy?

There is no single method to prevent jaundice in pregnancy. Below are some general precautions and preventive measures (4).

  • Have a healthy diet and maintain a healthy weight to keep your liver and body systems healthy.
  • Quit alcohol.
  • Make regular visits to your healthcare practitioner during pregnancy. Regular checkups might help detect any problems early.
  • Observe hygiene to prevent hepatitis infection. Wash hands before eating and always eat food cooked hygienically. Avoid sharing personal items, like plates, through the course of your pregnancy. Vaccination is available for some forms of hepatitis. Speak to your doctor about immunization against hepatitis.
  • If you have not conceived yet and have chronic liver disease, then consult a healthcare practitioner before planning your pregnancy.

Jaundice in pregnancy is rare, and early diagnosis of the condition is possible if you visit your doctor regularly. If you experience any unusual symptoms during your pregnancy, then get them checked to avoid any complications.

References:

1. Saketh R. Guntupalli and Jay Steingrub, Hepatic disease and pregnancy: an overview of diagnosis and management; Critical Care Medicine
2. Sherlock S.,Jaundice in pregnancy; British Medical Bulletin
3. Hay J. E.,Liver disease in pregnancy;American Association for the Study of Liver Diseases
4. Adult Jaundice; Cleveland Clinic
5. Weng M.T.et al., Hyperemesis gravidarum presenting as jaundice and transient hyperthyroidism complicated with acute pancreatitis; Journal of the Formosan Medical Association
6. Intrahepatic cholestasis of pregnancy; U.S. national Library of Medicine
7. Gupta A., Tiwari P., and Sachdeva P., A Case of Dubin-Johnson Syndrome in Pregnancy; Cureus
8. Liver Disease in Pregnancy; American Academy of Family Physicians
9. Diet and liver disease; University Hospitals Plymouth

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