Jaundice During Pregnancy: Definition, Causes, Diagnosis & Management

Jaundice During Pregnancy

1. Definition

Jaundice, or hyperbilirubinemia, is the yellow discoloration of the skin, sclera, and mucous membranes due to excess bilirubin. Clinically visible when serum bilirubin > 3 mg/dL (normal < 1 mg/dL) 0.

2. How Common Is It?

• Relatively rare: affects <5% of pregnancies globally 1.
• Responsible for ~12% of maternal deaths in some regions 2.

3. Causes of Jaundice in Pregnancy

1. Viral hepatitis (A, B, C, D, E) — most common overall, especially severe with hepatitis E 3.
2. Intrahepatic cholestasis of pregnancy (ICP) — characterized by itching and elevated bile acids; followed by jaundice in some cases 4.
3. Acute fatty liver of pregnancy (AFLP) — serious, occurs near term, often with nausea, vomiting, abdominal pain, and jaundice in ~70% 5.
4. HELLP / pre-eclampsia — hemolysis, elevated liver enzymes, low platelets; hepatic involvement may cause jaundice 6.
5. Hyperemesis gravidarum — severe vomiting in early pregnancy, can cause mild liver dysfunction and jaundice 7.
6. Gallstones / biliary obstruction — bile flow blockage causing jaundice 8.
7. Autoimmune or chronic liver disease — exacerbated during pregnancy 9.

4. Diagnosis

• History: itching, abdominal symptoms, vomiting, risk factors.
• Lab tests:
  • Liver function tests: bilirubin, ALT, AST, ALP, GGT, PT 10.
  • Serum bile acids (especially for ICP) 11.
• Rule out viral hepatitis via serology.
• Imaging (e.g., ultrasound) to detect gallstones or fatty liver changes.

5. Management

a) Viral Hepatitis

• Supportive care (hydration, nutrition); immunoglobulin or vaccine for hepatitis A exposure 12.
• Hepatitis B: antenatal screening, antivirals if indicated, newborn prophylaxis 13.
• Hepatitis E: high risk—manage supportively, close monitoring 14.

b) Intrahepatic Cholestasis of Pregnancy (ICP)

• Ursodeoxycholic acid (UDCA) at 10–15 mg/kg/day for symptom relief and bile acid reduction 15.
• Monitor bile acids and fetal well-being.
• Consider early delivery around 37–38 weeks to prevent stillbirth 16.
• Vitamin K supplementation if bleeding risk or pale stools 17.

c) AFLP

• Stabilize mother (IV fluids, glucose, blood products) 18.
• ICU care, fetal monitoring.
• Prompt delivery—often emergency Cesarean due to maternal/fetal compromise 19.

d) HELLP / pre-eclampsia

• Manage blood pressure, consider magnesium for seizure prophylaxis.
• Delivery based on gestational age and severity.

e) Hyperemesis Gravidarum

• Rest, antiemetics, IV fluids, electrolyte correction, thiamine if prolonged vomiting 20.

f) Gallstones / Biliary Obstruction

• Manage biliary obstruction; surgical intervention if needed, balancing risks in pregnancy.

6. Maternal & Fetal Risks

Condition	Maternal Risks	Fetal Risks
ICP	Intense pruritus, bleeding (vitamin K deficiency)	Preterm birth, fetal distress, stillbirth 21
AFLP / HELLP	Liver failure, DIC, maternal mortality 22	Preterm delivery, neonatal ICU, stillbirth
Viral Hepatitis	Liver dysfunction; HEV high mortality 23	Prematurity, vertical transmission (esp. HBV) 24
Hyperemesis	Dehydration, electrolyte imbalance	Rare complications from maternal malnutrition

7. FAQs

• Q: When should I worry about jaundice during pregnancy?
  A: Always contact your provider if you develop yellowing of eyes/skin or severe itching.
• Q: Does ICP affect future pregnancies?
  A: Yes—around 60% risk of recurrence; higher if severe 25.
• Q: Can medication treat jaundice in pregnancy?
  A: Yes,UDCA for ICP; antivirals or immunoglobulins for viral causes; supportive care for AFLP, hyperemesis.