Increased bilirubin during pregnancy: norm, causes and symptoms, treatment, consequences

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

The state of a woman's he alth directly affects the course of pregnancy and the outcome of childbirth. Systematic analyzes and examinations throughout the entire period of gestation allow for constant monitoring of indicators in order to respond in a timely manner to identified deviations from the norm, if necessary. One of the methods for diagnosing the condition of a pregnant woman is a biochemical blood test. It is he who allows you to diagnose elevated bilirubin during pregnancy. What does this indicator mean and what is its norm, we will tell in our article. Be sure to dwell on the reasons for its increase, symptoms and treatment methods.

What is bilirubin?

As a result of the natural breakdown of hemoglobin, the main bile pigment is formed, which looks likeyellow-brown rhombic crystals. This is bilirubin. It is found in the blood serum and bile. Almost 80% of this pigment is destroyed in the liver, and the remaining 20% in other tissues and organs.

Bilirubin can be connected (direct) and indirect. There is a significant difference between them. Together they make up total bilirubin. All three indicators must be indicated in blood tests, and not just one.

Direct bilirubin is only 4% of the total. It dissolves well in water, is filtered by the kidneys and excreted in the urine.

Indirect bilirubin accounts for 96% of the total. It is insoluble in water, toxic to the body, can easily penetrate into cells and disrupt their vital functions. Usually during pregnancy, the level of bilirubin does not change in any way and remains within the normal range. The woman feels great and the pregnancy proceeds without “surprises”. But sometimes deviations from the established norms are possible.

Causes of elevated bilirubin during pregnancy

An increase in the concentration of bile pigment in the blood serum indicates pathological changes in the liver or in other organs and tissues. Bilirubin deviation from the norm can be caused by both pregnancy and other diseases: These include:

• violation of the outflow of bile, as a result of which it does not enter the stomach, but into the blood;
• chronic and autoimmune hepatitis;
• gallstone disease;
• toxic and drug-induced hepatitis (poisoning with poisons ordrugs, including hormonal);
• biliary cirrhosis;
• acute viral hepatitis;
• sluggish pathological processes in the liver.

The results of a biochemical blood test can only show an increase in indirect bilirubin. In particular, other types of studies are prescribed, for example, liver tests. A blood test is done both general and biochemical. Pathology may be associated with impaired pigment processing or accelerated breakdown of red blood cells. Indirect bilirubin can be difficult to detect because it does not dissolve in water. The reasons for its increase include various anemias (congenital, secondary, toxic, drug-induced) and specific infections (malaria, sepsis, and others).

It is important to diagnose elevated bilirubin in time during pregnancy. This will avoid complications and conduct competent treatment.

Bilirubin is most commonly elevated for reasons unrelated to pregnancy. But sometimes an increase in the level of bile pigment should be sought precisely in the interesting position of a woman. These reasons include:

• severe early toxicosis;
• acute fatty liver;
• preeclampsia and eclampsia;
• intrahepatic cholestasis;
• stagnation of bile as a result of strong fetal pressure on the liver.

Symptoms of elevated bilirubin

If an increase in the concentration of bile pigment is caused by pathological processes in the liver, this leads toyellowness of the skin and darkening of the urine. At the same time, bilirubin in the blood first rises. In the urine, however, it can only be detected after a while.

If elevated bilirubin during pregnancy is caused by a severe form of eclampsia, the level of bile pigment in the blood exceeds the norm by 5-6 times. At the same time, the woman has symptoms such as fever, nausea, vomiting, abdominal pain.

Diagnosed intrahepatic cholestasis is manifested by itching all over the body and yellowness of the skin. Usually, this condition develops on the eve of childbirth as a response to an increase in the hormone estrogen and disappears on its own after the baby is born.

Thus, the symptoms of elevated bilirubin depend on the specific disease diagnosed in a woman. Depending on this, the appropriate treatment is prescribed.

Elevated bilirubin during early pregnancy

Most women who are carrying a baby are faced with a condition such as toxicosis. In some, it proceeds in a mild form, while in others it is accompanied by excruciating nausea and excessive vomiting, not only in the morning, but also during the day. Complex toxicosis is one of the causes of increased bilirubin during pregnancy.

It should be noted that such a condition in the early stages can be dangerous. Severe toxicosis often causes uterine tone, which, in turn, increases the risk of miscarriage. During this period, it is necessary to try to alleviate the condition of the pregnant woman as early as possible. After stopping the symptoms of toxicosis, bilirubin will return to normal after a while.yourself.

Diagnosis of pathology

You can determine the level of bilirubin in the blood using a biochemical analysis of blood or urine. But the last option is not always informative. For example, with an increase in indirect bilirubin, the indicators may be normal. That is why pregnant women are advised to take a biochemical blood test. Do not worry too much if the symptoms listed above are absent, and bilirubin is elevated. Perhaps the recommendations for passing the analysis were not followed:

1. Blood should be taken strictly on an empty stomach. The last meal should be no later than 20:00 of the previous day.
2. 2-3 days before the expected date of the test, you should refuse spicy, smoked and s alty dishes.
3. An expectant mother should try to relax, not be nervous, as stress can adversely affect results.

Norms of bilirubin in the blood of a pregnant woman

If, according to the results of the analysis, the level of bile pigment is high, the analysis must be retaken, but taking into account the recommendations above. The norm of bilirubin in pregnant women should be within the following limits:

• general - 3, 4-17, 1 µmol/L;
• bound – 0-7.9 µmol/L;
• indirect - below 19.1 µmol/l.

A significant upward deviation from the norm means that bilirubin is elevated during pregnancy and requires an immediate reduction. To do this, it is recommended to consult a gastroenterologist who will selectgentle therapy tailored to the woman's condition

Consequences for the expectant mother and fetus

Most often, an increase in bilirubin in the blood occurs in the last trimester of pregnancy. This is due to the huge load on the liver as a result of an increase in the size of the uterus. In turn, this condition leads to stagnation of bile and an increase in bilirubin. The consequences for pregnancy can be very different:

• With a slight increase in bile pigment (within 8, 4-20, 5 µmol/l), there is no danger for mother and child. Bilirubin levels return to normal immediately after delivery, when the load on the liver is less.
• With a sharp increase in pigment, there is a real threat to the condition of the mother and fetus. If the level of bilirubin is not lowered in time, the risk of premature birth or stillbirth is possible. For a mother, a high level of bile pigment can mean the development of hemolytic anemia or hepatitis.

What to do with elevated bilirubin?

To reduce the level of bile pigment in the blood and urine, it is necessary to find out the reason for its increase. This pathology is treated by a gastroenterologist. To make a correct diagnosis, a pregnant woman will need to once again pass the material for biochemistry and do an ultrasound of the abdominal cavity to check the condition of the liver and gallbladder.

With an increase in bilirubin in the blood during pregnancy, the following therapy is prescribed:

• diet that excludes foods harmful to the liver;
• medication allowed for pregnant womenbaby;
• compliance with the regime of the day, he althy sleep lasting 7-8 hours;
• taking chamomile-based medicinal decoctions (only after consulting a doctor);
• infusion therapy.

The choice of medicines depends on the cause that caused the increase in bilirubin. To improve the outflow of bile and normalize the functioning of the liver, the preparations "Essentiale", "Karsil", "Hofitol" can be prescribed. But in any case, all possible risks from taking them are first evaluated.

Prevention measures

To prevent an increase in total bilirubin during pregnancy, you must consciously treat your condition. And this means that you need to try to exclude all factors that can cause pathology.

To prevent an increase in bilirubin during pregnancy, it is recommended:

• follow proper nutrition and a he althy lifestyle;
• ditch caffeine in favor of purified drinking water;
• control the course of chronic diseases that can worsen during gestation;
• do not use drugs that are prohibited for pregnant women;
• do not collect or eat forest mushrooms, so as not to cause intoxication of the body;
• register at the antenatal clinic in time and follow all the doctor's recommendations.

Elevated bilirubin rarely returns to normal on its own. Therefore, at the slightest suspicion of pathology, it is necessary to immediatelysee a doctor.

Is low bilirubin dangerous during pregnancy

Until some time, the low level of bile pigment in the blood did not cause any concern among doctors. However, recent studies have shown that low bilirubin may be one of the signs of the development of the following conditions:

• non-hemolytic anemia;
• ischemic heart disease;
• depression.

It is worth noting that this pathology is extremely rare during pregnancy. Most often, it is diagnosed in expectant mothers who smoke.