A Guide to Jaundice During Pregnancy

Jaundice is caused when the liver does not function properly. The most visible symptom of jaundice is the yellowish discolouration of the sclera of the eyes, skin and urine. Liver disease during pregnancy includes a spectrum of diseases, which may occur during pregnancy and the postpartum period that result in abnormal liver function tests, hepatic and biliary system dysfunction, or sometimes both. It is observed in 3 to 10% of all pregnancies.

Causes of Jaundice

Pregnancy-Specific Causes:

• Hyperemesis Gravidarum– a condition where the mother-to-be experiences severe nausea accompanied with vomiting, electrolyte imbalance and weight loss
• Intrahepatic Cholestasis– a condition characterised by severe itching, as the normal flow of bile is interrupted
• Pre-Eclampsia– a condition where the mother has very high blood pressure and there is protein in the urine
• HELLP Syndrome– this is a liver disorder which is believed to be a severe form of pre-eclampsia and may be life-threatening
• Acute Fatty Liver- a liver disorder characterised by the accumulation of excessive fat in the liver

Causes Unrelated to Pregnancy:

• Primary Liver Disorders:

1. Acute Viral Hepatitis: HAV(Hepatitis A Virus) / HEV(Hepatitis E Virus)
2. Drug-induced hepatitis: PCM (paracetamol) overdose
3. Chronic hepatitis HBV (Hepatitis B Virus) / HCV(Hepatitis C Virus)
4. Autoimmune hepatitis
5. Wilson’s disease
6. Cirrhosis of Liver
7. Budd Chiari syndrome

• Pre-Hepatic (Liver) Causes: Conditions causing hemolytic anaemia like Malaria and Sickle Cell Anaemia
• Secondary Causes – Obesity, certain autoimmune diseases, congenital malformation or raised cholesterol levels

Signs and Symptoms of Jaundice When Pregnant

Following are the common signs & symptoms of the underlying liver disease:

• Yellowing of the eyes
• Yellowish tinge to the skin
• Dark coloured urine
• Itching
• Light coloured stools
• Weakness
• Loss of appetite
• Headache
• Nausea and vomiting
• Fever
• Swelling around the liver region
• Swelling of the legs, ankle, and feet

Diagnosing Jaundice During Pregnancy

Diagnosing liver disease during pregnancy can be challenging and depends on laboratory investigations. Signs and symptoms are mostly not very specific and can include vomiting, and pain in the stomach. The causative disease of jaundice can have a significant effect on the outcomes in both, the mother and the baby, and requires a battery of tests to be run. Here are the main ways in which jaundice is diagnosed:

• Clinical Evaluation

his may show skin changes, such as redness of palms of hands and cherry-like skin lesions. These changes occur due to high levels of oestrogen in pregnant women and occur in about 60% of healthy pregnancies.

• Abnormalities in Laboratory Test Results

Lab tests that show a low level of albumin (a plasma protein) in serum, elevated ALP or alkaline phosphatase, and elevated prothrombin time (PT) indicates a problem.

• Diagnostic Imaging

Ultrasonography is the first choice, since it is free of radiation risk to the foetus. Magnetic resonance imaging (MRI) may also be used. It is relatively safer than computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP), which are more specific diagnostic tools but involve a risk of radiation hazard for the baby.

Risks and Complications of Jaundice During Pregnancy

The effects on foetus because of jaundice in pregnancy are many. Risks include maternal and delivery-related problems as well as the direct impact on the foetus.

Maternal health risks include fulminant (severe impairment of liver function) or severe hepatitis (if not treated), hepatic encephalopathy (a neurological complication of severe liver damage), liver damage induced kidney problems like hepatorenal syndrome, liver Cirrhosis, abnormal bleedings like haemorrhagic varies, and a risk of liver malignancy in a few cases.

Delivery related complications include preterm deliveries, stillbirths, abruption placenta and postpartum haemorrhages, and risk of transmission of infections in the newborn during delivery.

Risks to the newborn include IUGR (intrauterine growth restriction), congenital hepatitis and neurological complications including kernicterus (brain damage in a newborn due to jaundice) and cerebral palsy in severe cases.

Treatments for Jaundice During Pregnancy

Treatment of jaundice during pregnancy is based on the causative factor and is majorly dependent on the time of recognition of the symptoms and the stage of pregnancy.

Common lines of treatment, irrespective of the cause of jaundice, include,

• Dietary Measures: Diets low in proteins and avoiding food and drugs harmful for the liver
• General Supportive Measures: Adequate rest, hydration, continuous monitoring of vital parameters like BP and urine output, supplemental oxygen and blood components as and when required with an intensive care facility

Specific management of jaundice depends upon the underlying conditions:

• Antivirals, vaccinations and interferons in viral hepatitis
• Antithrombotics in Budd Chiari syndrome or EHVT
• Treatment of specific causes of any hemolytic anaemia
• Surgical banding for variceal haemorrhages
• Shunt surgeries in cirrhosis of the liver
• Liver transplantation in end-stage liver disease

How To Prevent Jaundice

• Healthy Diet

You must consume fatty products like dairy foods and meat only in the recommended quantities, as excessive consumption may further affect your liver.

• Healthy Weight

Maintain a healthy weight and regulate cholesterol levels in the blood

• Regular Immunisations

Hepatitis can be prevented with effective vaccination. Your gynaecologist will advise you about it

• Limit the Consumption of Drugs

Avoid taking drugs or compounds that can be toxic to the liver. You should ask your doctor before popping any pills during pregnancy, as these can be harmful to your baby

• Be Alert While Travelling

Avoid travelling to regions that have a breakout of diseases like malaria. The malarial parasite destroys red blood cells, and this may lead to jaundice.

• Measuring and Reducing Risk Factors

Go for regular checkups. Seek medical help as soon as you notice symptoms of jaundice to avail early treatment and to ensure a speedy recovery. Jaundice during pregnancy can be managed when diagnosed in time.

Natural Home Remedies For Pregnancy Jaundice

You may also consider some home remedies for the treatment of jaundice during pregnancy. These are not medically proven, but you can try them in addition to your treatment for a faster recovery.

• Drinking fenugreek tea two to three times a day is very helpful in curing jaundice.
• Drinking one glass of tomato juice with a pinch of salt and pepper taken on an empty stomach in the morning is quite effective for jaundice.

Liver disease during pregnancy could be a mild disease with very few symptoms even if you have an abnormal liver function report. The issue may be resolved on its own, or it may develop into a potentially serious condition affecting your liver. It may even lead to permanent liver damage. Viral hepatitis infection is the most common reason for pregnancy jaundice. It is usually mild to moderate disease. Active treatment may not be needed except in hepatitis E and HSV infections.

Early detection of liver diseases in pregnancy, and an integrated approach by the treating gynaecologist, gastro physician, hepatologist and transplant specialist can help you manage the condition safely.