Jaundice During Pregnancy: Causes, Symptoms, Diagnosis, and Management

Jaundice during pregnancy is a serious medical condition that requires immediate attention. It is characterized by yellowing of the skin, eyes, and mucous membranes due to elevated bilirubin levels in the blood. While mild liver function changes may occur normally in pregnancy, jaundice is always considered pathological and may indicate underlying maternal or fetal risks.

What is Jaundice During Pregnancy?

Jaundice occurs when bilirubin builds up in the blood. In pregnancy, it is commonly associated with liver dysfunction, viral infections, or specific pregnancy-related disorders. It complicates about 3–5% of pregnancies worldwide and requires timely diagnosis and intervention to prevent complications.

Causes of Jaundice in Pregnancy

• Intrahepatic Cholestasis of Pregnancy (ICP): Characterized by itching and elevated bile acids, usually in the third trimester.
• Acute Fatty Liver of Pregnancy (AFLP): Rare but life-threatening liver disorder in late pregnancy.
• Viral Hepatitis: Hepatitis A, B, C, E infections are common causes globally.
• Preeclampsia & HELLP Syndrome: Severe forms of hypertensive disorders causing hemolysis and liver dysfunction.
• Hemolytic Disorders: Increased breakdown of red blood cells leading to elevated bilirubin.

Symptoms of Jaundice During Pregnancy

1. Yellow discoloration of eyes and skin
2. Severe itching (especially in ICP)
3. Dark urine and pale stools
4. Nausea, vomiting, and abdominal pain
5. Fatigue and loss of appetite
6. Swelling and high blood pressure (if associated with preeclampsia/HELLP)

Diagnosis of Jaundice in Pregnancy

Test	Purpose	Findings
Liver Function Tests (LFTs)	Assess bilirubin, ALT, AST, ALP	Elevated bilirubin and liver enzymes
Viral Hepatitis Serology	Detects hepatitis A, B, C, E infections	Positive viral markers
Ultrasound	Checks liver and gallbladder	Liver changes, gallstones, obstruction
Complete Blood Count (CBC)	Detect anemia or hemolysis	Low hemoglobin, abnormal RBCs

Complications of Jaundice in Pregnancy

• Preterm labor and delivery
• Stillbirth (common in untreated ICP)
• Maternal liver failure
• Fetal growth restriction
• Increased risk of maternal mortality

Treatment and Management

1. Hospitalization: For monitoring mother and fetus.
2. Medications: Ursodeoxycholic acid for ICP, antivirals for hepatitis, supportive care for AFLP/HELLP.
3. Fluid and Electrolyte Balance: Essential in preventing maternal complications.
4. Fetal Monitoring: Regular non-stress tests and ultrasound to check fetal well-being.
5. Timely Delivery: In severe cases, early delivery may be recommended to save mother and baby.

References

1. Royal College of Obstetricians and Gynaecologists (RCOG). Obstetric Cholestasis Guidelines. 2022.
2. American College of Obstetricians and Gynecologists (ACOG). Acute fatty liver of pregnancy: Clinical management. 2023.
3. World Health Organization (WHO). Viral hepatitis in pregnancy – maternal and neonatal risks. 2021.

Disclaimer

This article is for educational and informational purposes only. It is not a substitute for medical advice. Pregnant women experiencing yellowing of skin or eyes should seek immediate care from a qualified healthcare provider.

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