Jaundice in pregnant women: Causes, risks to mother and baby, maternal and delivery complications, precautions

Though relatively rare in pregnant women, jaundice is the yellowing of the skin, eyes and mucous membranes and sometimes starts in early pregnancy but has potentially serious consequences for maternal and fetal health.

Jaundice in pregnancy occurs when bilirubin levels are greater than 2 mg/dl since the normal bilirubin levels range up to 0.1 to 1.2 mg/dl.

Causes:

In an interview with HT Lifestyle, Dr Rana Choudhary, Consultant Obstetrician, Gynaecologist and Fertility Specialist at Mumbai’s Masina Hospital, revealed that the causes of jaundice in pregnancy are:

1. Liver damage due to infections, drug toxicity, pregnancy associated conditions like cholestasis, pre-eclampsia and auto-immune hepatitis or medical conditions like cirrhosis or cancers.

2. Haemolysis, which is the damage to red blood cells due to various causes and which leads to an increased production in bilirubin.

3. Obstruction to the flow of bile with gallbladder diseases like blockage in the bile duct due to its narrowing or stones or tumours.

The most common causes in pregnancy are pre eclampsia or gall stones. According to Dr Anagha Chhatrapati, Consultant- Gynaecology at Mumbai’s Global Hospital, the various causes of jaundice in pregnancy are:

a) Not related to pregnancy

1. Viral Hepatitis – Hepatitis A and E spread through consumption of contaminated food or water. Hepatitis A has mild course and it is self limiting. But Hepatitis E can lead to fulminating hepatic failure with a mortality rate as high as 20% in infected women.

2. Hepatitis B and C – Generally they are chronic infections spread by sexual activity or haematogenous route. It can lead to acute hepatitis leading to jaundice.

3. Drug induced hepatitis – Some medication like paracetamol or anti tuberculosis drugs can lead to liver damage

4. Autoimmune hepatitis – It is very rare condition leading to self antibiotics causing destruction of Liver

5. Cirrhosis of liver – It’s a chronic condition which is due to fibrosis of liver leading to shrinkage and liver failure

b) Conditions related to pregnancy

1. High Blood pressure leading to HELLP syndrome – Preeclampsia or high BP during pregnancy can cause liver to fail leading to jaundice

2. Cholestasis of pregnancy – Generally seen in last 3 months of pregnancy. It can lead to intrauterine fetal death if not treated appropriately

3. Acute fatty liver of pregnancy – very rare condition where liver failure occurs suddenly. Seen in only pregnancy. It has very high mortality.

Risks and complications:

Dr Rana Choudhary highlighted, “In most pregnant women, jaundice is mild and can be managed successfully however, in certain situations like pre-eclampsia or HELLP syndrome and other medical illnesses, it can be associated with unfavourable outcomes, both in the mother and baby depending upon the severity of liver damage.”

Maternal complications-

1. Severe liver damage leading to liver failure and death

2. Neurological complications

3. Renal shutdown and tendency to bleed

Risks to the baby-

1. Preterm labour and preterm delivery

2. Inadequate oxygenation and growth of baby

3 Death of baby in womb and stillbirth

4. Transmission of infections like viral hepatitis B and E from mother to baby

Delivery complications-

1. Fetal distress and

meconium stained liquor

2. Higher chances of caesarean delivery

3. Heavy bleeding before or after delivery

4. Blood transfusion

5. ICU admission

Adding to the list of risks of jaundice during pregnancy, Dr Anagha Chhatrapati elaborated:

a) Risk to mother

1. Fulminating liver failure can lead to sudden death

2. Hepatic encephalopathy leading to failure of brain function

3. Kidney damage as a part of hepatorenal syndrome

4. Severe bleeding due to coagulation failure

This can happen before delivery , during delivery or afterwards leading to maternal death.

b) Fetal risks

1. Intrauterine fetal death – High bilirubin level in mother can lead to death of baby in utero

2. Preterm delivery leading to high mortality

3. Risk of neonatal jaundice and kernicterus (newborn brain damage)

4. Risk of cerebral palsy

5. Risk of transmission of Hepatitis B or C to newborn

Precautions:

Talking about what precautions pregnant women should take to avoid jaundice, Dr Anagha Chhatrapati advised –

1. Avoid eating roadside and contaminated food to avoid infectious hepatitis A or E

2. Take vaccination against Hepatitis B

3. Avoid high risk sexual activity to prevent Hepatitis B or C infection

4. Maintenance of ideal BMI to avoid fatty liver

5. Regular antenatal check-ups can help detect hypertension and related complications earlier

6. Do not self medicate to avoid hepatotoxicity

However, Dr Rana Choudhary asserted, “Jaundice can affect anyone during pregnancy and unfortunately there are no specific ways to prevent it. Idiopathic cholestasis of pregnancy (ICP) is particularly the result of pregnancy hormones and it can occur again in the next pregnancy in 25% women. It is important, however, for pregnant women to strictly follow basic hygiene practices.” She recommended –

1. Avoid eating from roadside outlets

2. Wash hands after and before every meal

3. Avoid oily and deep fried foods that build bad cholesterol and

4. Get all necessary vaccinations on time to stop the spread of infectious diseases eg Hep B etc.