What Is Jaundice During Pregnancy?
Jaundice occurs when the level of bilirubin in the blood increases, causing the eyes, urine, and skin to become yellow. When this occurs in a pregnant woman, it is called jaundice during pregnancy. A pregnant woman may develop jaundice for several different reasons. Some causes can seriously affect both the mother and the baby.
Causes of Jaundice During Pregnancy
Approximately 50% of cases of jaundice during pregnancy may be associated with different hepatitis viruses, including hepatitis A, B, and E. Among these, hepatitis E can be particularly severe during pregnancy. If infection occurs during the last three months of pregnancy, it can sometimes cause sudden and severe liver failure (acute fulminant hepatic failure). In severe cases, it can be the cause of death for around 15–25% of these pregnant women.
In 56% of cases, hepatitis E infection during pregnancy can also increase the risk of pregnancy loss (miscarriage), premature delivery, and newborn death, particularly when the mother's illness is severe.
Another important virus is hepatitis B virus (HBV). HBV can be transmitted from an infected mother to her newborn. If a mother tests positive for HBeAg or HBV-DNA, the risk of transmitting HBV to the newborn can turn out to be approximately 70%–90% without appropriate preventive measures. Even when HBeAg is negative, transmission can still occur, with a reported risk of approximately 10%–20% in some circumstances.
In Bangladesh, hepatitis B infection is present amongst 0.5–3.5% of pregnant women, and without appropriate prevention, infected mothers can transmit the virus to their newborns.
Other Causes of Jaundice During Pregnancy
- Intrahepatic cholestasis of pregnancy (ICP): An abnormal buildup of bile within the liver that can cause itching and, in some cases, jaundice.
- Toxemia of Pregnancy, Preeclampsia and Eclampsia: Severe pregnancy complications can affect liver function. These may cause seizures and loss of consciousness and can become life-threatening by impairing liver function.
- HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelet count): A serious pregnancy complication involving excessive breakdown of red blood cells, elevated liver enzymes, and a low platelet count. It usually occurs in the later stages of pregnancy (third trimester) and requires rapid diagnosis and treatment. Without appropriate treatment, it can lead to liver failure, kidney failure, disseminated intravascular coagulation (DIC), and death.
- Infections of the bile ducts or gallbladder, or a stone blocking a bile duct, can cause obstructive jaundice.
- A pre-existing liver disease may become more serious during pregnancy.
- Certain medications used during pregnancy can cause liver injury and jaundice as a side effect.
What Should You Do If You Develop Jaundice During Pregnancy?
Jaundice during pregnancy must be taken seriously because it can affect both the mother and the baby. This can result in maternal mortality ranging from approximately 10% to 45%.
Severe liver disease during pregnancy can increase the risk of premature delivery, low birth weight, and severe newborn complications such as kernicterus, a form of brain damage caused by very high levels of bilirubin. The underlying cause of jaundice must therefore be identified as quickly as possible.
Prompt and appropriate treatment is essential to protect the lives of both the mother and the baby. Pregnant women with jaundice should be managed under the supervision of both a liver specialist and an obstetrician/gynecologist, when appropriate.
If a pregnant woman has hepatitis B, particularly if she is HBeAg/HBV-DNA positive, her newborn should receive:
- Hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.
- Hepatitis B immune globulin (HBIG) when indicated.
- The remaining doses of the hepatitis B vaccine according to the recommended schedule.
A commonly used schedule is 0, 1, and 6 months, meaning the first dose at birth, the second dose about one month later, and the third dose about six months after the first dose.
If the mother's HBV DNA level is higher than 20,000, antiviral treatment during pregnancy may be recommended to reduce the risk of transmission to the baby.
What Should You Avoid If You Develop Jaundice During Pregnancy?
Avoid faith healing, ritual treatments, folk remedies, and other unscientific treatments. These practices may delay proper diagnosis and treatment or may themselves cause serious liver damage, putting both the mother and newborn at risk. The correct cause of jaundice should be identified, and medical care should be sought without delay.
Preventing Jaundice and Hepatitis During Pregnancy
- Take appropriate measures to prevent hepatitis E and other hepatitis infections.
- Drink clean, safe water.
- Avoid using ice in drinks when you are uncertain whether the water used to make the ice was safe.
- Wash fruits and vegetables thoroughly with clean, safe water before eating them.
- Follow general hygiene and infection-prevention practices.