Skip to main content
Erschienen in: Digestive Diseases and Sciences 2/2017

01.09.2016 | Original Article

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

verfasst von: Sangeethapriya Duraiswamy, Jeanne S. Sheffield, Donald Mcintire, Kenneth Leveno, Marlyn J. Mayo

Erschienen in: Digestive Diseases and Sciences | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Harish K, Nitha R, Harikumar R, et al. Prospective evaluation of abnormal liver function tests in pregnancy. Trop Gastroenterol. 2005;26:188–193.PubMed Harish K, Nitha R, Harikumar R, et al. Prospective evaluation of abnormal liver function tests in pregnancy. Trop Gastroenterol. 2005;26:188–193.PubMed
2.
3.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
4.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Hay J. Viral hepatitis in pregnancy. Viral Hepat Rev. 2000;6:205–215. Hay J. Viral hepatitis in pregnancy. Viral Hepat Rev. 2000;6:205–215.
8.
Zurück zum Zitat Mishra L, Seeff LB. Viral hepatitis, A though E, complicating pregnancy. Gastroenterol Clin North Am. 1992;21:873–887.PubMed Mishra L, Seeff LB. Viral hepatitis, A though E, complicating pregnancy. Gastroenterol Clin North Am. 1992;21:873–887.PubMed
9.
Zurück zum Zitat Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol. 2006;5:231–236.PubMed Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol. 2006;5:231–236.PubMed
10.
Zurück zum Zitat 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. 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.
Zurück zum Zitat D’Cruz IA, Balani SG, Iyer LS. Infectius hepatitis and pregnancy. Obstet Gynecol. 1968;31:449–455.PubMed D’Cruz IA, Balani SG, Iyer LS. Infectius hepatitis and pregnancy. Obstet Gynecol. 1968;31:449–455.PubMed
12.
Zurück zum Zitat Naidu SS, Viswanathan R. Infectious hepatitis in pregnancy during Delhi epidemic. Indian J Med Res. 1957;45:71–76.PubMed Naidu SS, Viswanathan R. Infectious hepatitis in pregnancy during Delhi epidemic. Indian J Med Res. 1957;45:71–76.PubMed
13.
Zurück zum Zitat Haemmerli U. Jaundice during pregnancy. Acta Med Scand. 1966;444:23–30. Haemmerli U. Jaundice during pregnancy. Acta Med Scand. 1966;444:23–30.
14.
Zurück zum Zitat 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.PubMed 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.PubMed
15.
Zurück zum Zitat Cahill KM. Hepatitis in pregnancy. Surg Gynecol Obstet. 1962;114:545–552.PubMed Cahill KM. Hepatitis in pregnancy. Surg Gynecol Obstet. 1962;114:545–552.PubMed
16.
Zurück zum Zitat Peretz A, Paldi E, Brandstaedter S, Barzilai D. Infectious hepatitis in pregnancy. Obstet Gynecol. 1959;14:435–441.PubMed Peretz A, Paldi E, Brandstaedter S, Barzilai D. Infectious hepatitis in pregnancy. Obstet Gynecol. 1959;14:435–441.PubMed
18.
Zurück zum Zitat Hieber JP, Dalton D, Shorey J, Combes B. Hepatitis and pregnancy. J Pediatr. 1977;91:545–549.CrossRefPubMed Hieber JP, Dalton D, Shorey J, Combes B. Hepatitis and pregnancy. J Pediatr. 1977;91:545–549.CrossRefPubMed
21.
Zurück zum Zitat Table 1: Reported cases of acute viral hepatitis, by type and year, United States, 1966–2003. Table 1: Reported cases of acute viral hepatitis, by type and year, United States, 1966–2003.
23.
Zurück zum Zitat 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.PubMed 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.PubMed
24.
Zurück zum Zitat Borhanmanesh F, Haghighi P, Hekmat K, Rezaizadeh K, Ghavami AG. Viral hepatitis during pregnancy. Severity and effect on gestation. Gastroenterology. 1973;64:304–312.PubMed Borhanmanesh F, Haghighi P, Hekmat K, Rezaizadeh K, Ghavami AG. Viral hepatitis during pregnancy. Severity and effect on gestation. Gastroenterology. 1973;64:304–312.PubMed
25.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
27.
Zurück zum Zitat Larsson A, Palm M, Hansson LO, Axelsson O. Reference values for clinical chemistry tests during normal pregnancy. BJOG. 2008;115:874–881.CrossRefPubMed Larsson A, Palm M, Hansson LO, Axelsson O. Reference values for clinical chemistry tests during normal pregnancy. BJOG. 2008;115:874–881.CrossRefPubMed
28.
29.
Zurück zum Zitat Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989;149:1750–1753.CrossRefPubMed Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989;149:1750–1753.CrossRefPubMed
30.
Zurück zum Zitat Amaral JF, Thompson WR. Gallbladder disease in the morbidly obese. Am J Surg. 1985;149:551–557.CrossRefPubMed Amaral JF, Thompson WR. Gallbladder disease in the morbidly obese. Am J Surg. 1985;149:551–557.CrossRefPubMed
Metadaten
Titel
Updated Etiology and Significance of Elevated Bilirubin During Pregnancy: Changes Parallel Shift in Demographics and Vaccination Status
verfasst von
Sangeethapriya Duraiswamy
Jeanne S. Sheffield
Donald Mcintire
Kenneth Leveno
Marlyn J. Mayo
Publikationsdatum
01.09.2016
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 2/2017
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-016-4282-3

Weitere Artikel der Ausgabe 2/2017

Digestive Diseases and Sciences 2/2017 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.