Jaundice occurs when either your skin or the whites of your eyes turn into a yellowish colour. It is caused by an excessive buildup of bilirubin, which is a bile pigment in the blood. While it may not be cause for major concern, it can be a symptom of a very severe condition indeed, which means you should seek medical attention at your earliest convenience.
Jaundice is fairly rare, and occurs in approximately 1 in 1500 pregnancies, according to the British Medical Journal. Whilst it is likely you will not suffer from jaundice during your pregnancy, it is worth noting the signs, symptoms, potential causes, and when you should seek medical assistance.
Symptoms of Jaundice
Bilirubin is a yellowish compound produced in the body following the breakdown of blood cells and is potentially toxic. If your body is operating as it should, these are passed out of your digestive system and the urine without issue. Bilirubin is the reason your urine is yellow in colour, for example.
If your body is not able to process bilirubin properly, however, it can lead to the most common symptom, which is developing a yellowish tinge to the skin. It can be quite subtle, but nevertheless noticeable. However, this does not happen in all cases, with a yellowing of the eyes also being a sign of jaundice.
These primary symptoms are often accompanied by a darker colour of urine, itching, general feeling of weakness, loss of appetite, fever, frequent headaches, change in the colour of your stool, nausea and vomiting, fever and swelling of the liver.
Jaundice Diagnosis During Pregnancy
You should always consult your healthcare professional, should you notice the primary signs of jaundice. Your doctor will usually first check for a noticeable yellowing of the skin, which we have established as the most common symptom above.
Further tests may be done to determine the level of bilirubin in your blood/urine. Hepatitis viral tests will also be conducted to check whether you are suffering from any of the associated infections. Liver enzyme tests, conducted through a blood test, can check the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
Ultrasounds can point to whether your liver is oversized. It is a non-invasive procedure, with no associated risks. It can pinpoint associated issues of disease, although there are limitations in assessing the gallbladder and bile ducts. Your doctor may also choose to run a CT scan, particularly when an obstruction is not apparent. It is a painless procedure, essentially an advanced type of x-ray test. In very rare cases, you may undergo a liver biopsy to determine the cause of your jaundice.
Causes of Jaundice During Pregnancy
Jaundice can be caused by a wide variety of problems in the body, with three types of classification. There is pre-hepatic, which is before the liver (for example, the breakdown of blood cells to excessive levels). Intra-hepatic occurs in the liver, which can be caused by biliary duct diseases. Finally, there are post-hepatic issues, or after the liver, which can be associated with pancreatic disease, the gallbladder or large bile ducts.
There are specific conditions related to your pregnancy, which may cause jaundice:
Pre-eclampsia, with associations to HELLP syndrome. Pre-eclampsia occurs during the second or third trimester, affecting 5-10% of expecting women. HELLP occurs in 0.5–0.9% of all pregnancies, but in 10-20% of cases where there is severe pre-eclampsia.
Hyperemesis gravidarum. Usually mild, but nausea and vomiting that persist can progress to hyperemesis gravidarum, which can cause issues to the central nervous system, liver failure or kidney problems.
Acute fatty liver. This is very rare, occurring in just 0.005-0.001% of expecting mothers. Risk factors are thought to include first pregnancies, male fetuses and twin pregnancies.
Intrahepatic cholestasis (ICP). Most often occurring within the third trimester, it is the most common hepatic condition during pregnancy. The causes are thought to be a combination of environmental and genetic conditions.
source: https://www.slideshare.net/dranusharp/jaundice-in-pregnancy-41553152
Jaundice May Not Be Related to Your Pregnancy
Of course, it is very important to keep in mind that experiencing jaundice whilst expecting does not necessarily mean it has anything to do with the pregnancy itself. There are other causes that are entirely unrelated, some of which require immediate medical attention. They can include:
Sickle cell disease. Affecting the red blood cells, sickle cell anemia is perhaps the most serious of these, requiring life-long treatment.
Pancreatitis. This occurs when there is a short-term inflammation of the pancreas, usually accompanied by severe abdomen pain. If it is severe, contact a health professional.
Hepatitis. Inflammation of the liver - often not a cause for concern. However, there are different types, and if you are jaundiced, see your doctor. It is the most common cause not related to pregnancy.
Gallstones. Formed in the gallbladder, these small stones consist of cholesterol (in most cases).
Liver disease due to alcohol abuse. ARLD is a serious condition, with no specific treatment other than not consuming alcohol.
Jaundice Treatment
It is important to note that jaundice is not a disorder or condition in and of itself, but rather a sign of another health problem (which in turn causes jaundice). Therefore, treatment plans will differ depending on your doctor’s diagnosis.
In general, however, you should try and rest as much as possible. Eat little portions, but often, consume enough water throughout the day. Avoid alcohol, and ensure you follow all medical advice throughout your pregnancy.
What About Jaundice in Newborns?
Jaundice during pregnancy may lead you to wonder whether it may affect your newborn. The answer is that it is quite common but fortunately harmless in most cases. Approximately 60% of newborns will develop jaundice. For premature babies, it is as many as 80%. The specific medical term for it is neonatal jaundice, and includes these symptoms:
Dark or yellow urine. Newborns should have colourless urine.
Poo that is pale or lighter in color. For babies, poo should be orange or yellow in cololur.
Neonatal jaundice will usually develop within 3 days of your baby being born, with most recovering without the need for treatment in roughly 14 days. A check for jaundice in newborns is a part of the initial, post birth physical examination.
Should your baby develop symptoms after this time, be sure to mention it to your midwife, doctor or other health professional. Even though neonatal jaundice is usually not serious, it is important for your doctor to determine whether treatment is required.
Seek Medical Attention
Jaundice does not immediately translate to a sinister cause or something you should be very worried about; do not panic, but take added care. Be aware that it is a symptom of a potentially serious issue, which means you should never take jaundice lightly.
During pregnancy, it is helpful to become aware of your health and any changes over time, even if subtle. Consider keeping a journal to monitor your journey, which will also help your doctor, midwife, and other health professionals.
Should you develop jaundice, seek medical advice as soon as possible. You may be feeling okay otherwise, but please let your doctor decide on the next steps. The best thing you can do is not to ignore the problem or attempt to explain it away (e.g. ‘it’s not that yellow!), as this route can only exacerbate the situation.