Skip to main content

Advertisement

SpringerLink
Log in

Updated Etiology and Significance of Elevated Bilirubin During Pregnancy: Changes Parallel Shift in Demographics and Vaccination Status

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

The most common cause of jaundice during pregnancy in the United States (US) is still attributed to viral hepatitis, despite the dramatic drop in incidence of viral hepatitis in the US.

Objective

We hypothesized that viral hepatitis is no longer a frequent etiology of jaundice among the pregnant population in the US and sought to identify the contemporary causes of elevated bilirubin during pregnancy as well as to quantify the associated risk to the mother and fetus.

Study Design

Clinical data from all pregnant women who delivered an infant between 2005 and 2011 at a single hospital in Dallas, Texas, were ascertained using prospectively collected computerized databases. Women with elevated total bilirubin (>1.2 mg/dl) were analyzed to determine the cause of hyperbilirubinemia and maternal and fetal outcomes.

Results

Out of a total of 80,857 consecutive deliveries, there were 397 (0.5 %) pregnancies with hyperbilirubinemia. The most common etiology was gallstones (98/397 = 25 %), followed by preeclampsia/eclampsia/HELLP (94/397 = 24 %) and intrahepatic cholestasis of pregnancy (53/397 = 13 %). Adverse infant outcomes, including stillbirths, fetal malformations, neonatal deaths, and small for gestational age births, were more common in the women with hyperbilirubinemia during pregnancy, but there were no maternal deaths.

Conclusions

Acute viral hepatitis is no longer a common cause of jaundice in pregnant women in the US. In the current era, gallstones and preeclampsia-related disorders are the most common causes of jaundice in pregnant women. Disorders that cause elevated maternal bilirubin during pregnancy are associated with increased risk for the fetus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Harish K, Nitha R, Harikumar R, et al. Prospective evaluation of abnormal liver function tests in pregnancy. Trop Gastroenterol. 2005;26:188–193.

    CAS  PubMed  Google Scholar 

  2. Ch’ng CL, Morgan M, Hainsworth I, Kingham JG. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut. 2002;51:876–880.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Devarbhavi H, Kremers WK, Dierkhising R, Padmanabhan L. Pregnancy-associated acute liver disease and acute viral hepatitis: differentiation, course and outcome. J Hepatol. 2008;49:930–935.

    Article  PubMed  Google Scholar 

  4. Ahmed KT, Almashhrawi AA, Rahman RN, Hammoud GM, Ibdah JA. Liver diseases in pregnancy: diseases unique to pregnancy. World J Gastroenterol. 2013;19:7639–7646.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kamimura K, Abe H, Kawai H, et al. Advances in understanding and treating liver diseases during pregnancy: a review. World J Gastroenterol. 2015;21:5183–5190.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Hay J. Viral hepatitis in pregnancy. Viral Hepat Rev. 2000;6:205–215.

    Google Scholar 

  7. Riely CA. Hepatic disease in pregnancy. Am J Med. 1994;96:18S–22S.

    Article  CAS  PubMed  Google Scholar 

  8. Mishra L, Seeff LB. Viral hepatitis, A though E, complicating pregnancy. Gastroenterol Clin North Am. 1992;21:873–887.

    CAS  PubMed  Google Scholar 

  9. Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol. 2006;5:231–236.

    PubMed  Google Scholar 

  10. Hay JE. Liver Disease and Pregnancy. In: Hauser, SC, Pardi, DS, Poterucha, JJ, editors. Mayo Clinic gastroenterology and hepatology board review. 3rd ed. Mayo Clinic Scientific Press; 2008. p. 419–430.

  11. D’Cruz IA, Balani SG, Iyer LS. Infectius hepatitis and pregnancy. Obstet Gynecol. 1968;31:449–455.

    PubMed  Google Scholar 

  12. Naidu SS, Viswanathan R. Infectious hepatitis in pregnancy during Delhi epidemic. Indian J Med Res. 1957;45:71–76.

    CAS  PubMed  Google Scholar 

  13. Haemmerli U. Jaundice during pregnancy. Acta Med Scand. 1966;444:23–30.

    Google Scholar 

  14. Bennett NM, Forbes JA, Lucas CR, Kucers A. Infective hepatitis and pregnancy: analysis of liver function test results. Med J Aust. 1967;2:974–976.

    CAS  PubMed  Google Scholar 

  15. Cahill KM. Hepatitis in pregnancy. Surg Gynecol Obstet. 1962;114:545–552.

    CAS  PubMed  Google Scholar 

  16. Peretz A, Paldi E, Brandstaedter S, Barzilai D. Infectious hepatitis in pregnancy. Obstet Gynecol. 1959;14:435–441.

    CAS  PubMed  Google Scholar 

  17. Adams RH, Combes B. Viral hepatitis during pregnancy. JAMA. 1965;192:195–198.

    Article  CAS  PubMed  Google Scholar 

  18. Hieber JP, Dalton D, Shorey J, Combes B. Hepatitis and pregnancy. J Pediatr. 1977;91:545–549.

    Article  CAS  PubMed  Google Scholar 

  19. Hay JE. Liver disease in pregnancy. Hepatology. 2008;47:1067–1076.

    Article  PubMed  Google Scholar 

  20. Disease burden from viral hepatitis A, B and C in the United States. Available at: http://www.cdc.gov/hepatitis/pdfs/disease burden.pdf.

  21. Table 1: Reported cases of acute viral hepatitis, by type and year, United States, 1966–2003.

  22. Table 2.1 Reported cases of acute hepatitis A, by state—United States, 2006–2010. Viral Hepatitis Statistics & Surveillance. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/hepatitis/Statistics/2010Surveillance/Table2.1.htm.

  23. Wong HY, Tan JY, Lim CC. Abnormal liver function tests in the symptomatic pregnant patient: the local experience in Singapore. Ann Acad Med Singapore. 2004;33:204–208.

    CAS  PubMed  Google Scholar 

  24. Borhanmanesh F, Haghighi P, Hekmat K, Rezaizadeh K, Ghavami AG. Viral hepatitis during pregnancy. Severity and effect on gestation. Gastroenterology. 1973;64:304–312.

    CAS  PubMed  Google Scholar 

  25. Cunningham FG, Leveno K, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Appendix. Reference Table of Normal Laboratory Values in Uncomplicated Pregnancies. Williams Obstetrics. 23rd ed.

  26. Bacq Y, Zarka O, Brechot JF, et al. Liver function tests in normal pregnancy: a prospective study of 103 pregnant women and 103 matched controls. Hepatology. 1996;23:1030–1034.

    Article  CAS  PubMed  Google Scholar 

  27. Larsson A, Palm M, Hansson LO, Axelsson O. Reference values for clinical chemistry tests during normal pregnancy. BJOG. 2008;115:874–881.

    Article  CAS  PubMed  Google Scholar 

  28. Lockitch G. Clinical biochemistry of pregnancy. Crit Rev Clin Lab Sci. 1997;34:67–139.

    Article  CAS  PubMed  Google Scholar 

  29. Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989;149:1750–1753.

    Article  CAS  PubMed  Google Scholar 

  30. Amaral JF, Thompson WR. Gallbladder disease in the morbidly obese. Am J Surg. 1985;149:551–557.

    Article  CAS  PubMed  Google Scholar 

  31. 2010 US Census data-Dallas County. Available at: Dallas County, Texas. American FactFinder. US Department of Commerce. United States Census Bureau. http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml.

  32. Newsroom; U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now. Available at: http://www.census.gov/newsroom/releases/archives/population/cb12-243.html.

  33. Overweight and Obesity: Adult Obesity Facts. Available at: http://www.cdc.gov/obesity/data/adult.html.

Download references

Author information

Authors and Affiliations

  1. Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9151, USA

    Sangeethapriya Duraiswamy & Marlyn J. Mayo

  2. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jeanne S. Sheffield, Donald Mcintire & Kenneth Leveno

Authors
  1. Sangeethapriya Duraiswamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeanne S. Sheffield
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donald Mcintire
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenneth Leveno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marlyn J. Mayo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marlyn J. Mayo.

Ethics declarations

Conflict of interest

The authors report no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duraiswamy, S., Sheffield, J.S., Mcintire, D. et al. Updated Etiology and Significance of Elevated Bilirubin During Pregnancy: Changes Parallel Shift in Demographics and Vaccination Status. Dig Dis Sci 62, 517–525 (2017). https://doi.org/10.1007/s10620-016-4282-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-016-4282-3

Keywords

Search

Navigation