Elevated bilirubin in pregnancy

Elevated bilirubin in pregnancy - causes and treatment

Bilirubin is subdivided into direct and indirect, and they both constitute a common bilirubin (that is why in the analyzes we see three indicators of this pigment).

The share of direct bilirubin accounts for only 4% - it is soluble in water, filtered by the kidneys and excreted in the urine.

The remaining 96% of bilirubin in the blood falls on the indirect pigment, which is insoluble in water and toxic (it is able to easily penetrate the cell membranes and disrupt the vital functions of cells).

Usually pregnancy does not affect bilirubin level at all, and its value remains within the norm (in blood plasma - 3, 4-22, 2 ?mol / l, and daily in the urine is released in the form of urobilinogen 4 mg). However, there are cases when these indicators increase significantly or slightly.

In what cases, the level of bilirubin may increase?

Bilirubin in the blood, and then in the urine, rises with certain pathologies of the liver, and this causes jaundice and darkening of the urine.

The causes of increased bilirubin in the blood may be several.

For example, the level of direct bilirubin in the blood increases due to a violation of the outflow of bile - it is not directed to the stomach, but to the blood, and the following pathologies may become the causes of this:

  • chronic hepatitis,
  • autoimmune hepatitis,
  • cholelithiasis,
  • viral hepatitis in acute form (hepatitis A, B, infectious mononucleosis),
  • bacterial hepatitis (brucellosis, leptospirosis),
  • toxic hepatitis (poisoning with industrial toxic substances or fungal poisons),
  • medical hepatitis (as a result of therapy with nonsteroidal anti-inflammatory drugs, hormonal drugs, antitumor drugs and antituberculosis drugs ),
  • biliary cirrhosis,
  • Rotor syndrome, Dhabi on-Johnson,
  • cancer of the liver, gallbladder or pancreas.

The reasons for increasing indirect bilirubin can also be several, and they are most often associated with a disruption in the processing of indirect bilirubin or with accelerated decay of erythrocytes. However, since indirect bilirubin does not dissolve in water, even with a significant increase in blood in the urinalysis, there will be no deviations.

The reasons for the increase in indirect bilirubin may be as follows:

  • congenital hemolytic anemia,
  • secondary hemolytic anemia (against a background of certain diseases such as lymphogranulomatosis , lymphocytic leukemia, rheumatoid arthritis, etc.),
  • medical hemolytic anemia that is associated with the use of certain drugs (eg, aspirin, insulin, levomycetin, etc.),
  • toxic and they are most often associated with impaired processing of indirect bilirubin or with accelerated decay of erythrocytes. However, since indirect bilirubin does not dissolve in water, even with a significant increase in blood in the urinalysis, there will be no deviations.

    The reasons for the increase in indirect bilirubin may be as follows:

    • congenital hemolytic anemia,
    • secondary hemolytic anemia (against a background of certain diseases such as lymphogranulomatosis , lymphocytic leukemia, rheumatoid arthritis, etc.),
    • medical hemolytic anemia that is associated with the use of certain drugs (eg, aspirin, insulin, levomycetin, etc.),
    • toxic and they are most often associated with impaired processing of indirect bilirubin or with accelerated decay of erythrocytes. However, since indirect bilirubin does not dissolve in water, even with a significant increase in blood in the urinalysis, there will be no deviations.

      The reasons for the increase in indirect bilirubin may be as follows:

      • congenital hemolytic anemia,
      • secondary hemolytic anemia (against a background of certain diseases such as lymphogranulomatosis , lymphocytic leukemia, rheumatoid arthritis, etc.),
      • medical hemolytic anemia that is associated with the use of certain drugs (eg, aspirin, insulin, levomycetin, etc.),
      • toxic since indirect bilirubin does not dissolve in water, even if there is a significant increase in blood in the urine analysis, there will be no deviations.

        The reasons for the increase in indirect bilirubin may be as follows:

        • congenital hemolytic anemia,
        • secondary hemolytic anemia (against a background of certain diseases such as lymphogranulomatosis , lymphocytic leukemia, rheumatoid arthritis, etc.),
        • medical hemolytic anemia, which are associated with the use of certain drugs (eg, aspirin, insulin, levomycetin, etc.),
        • toxic since indirect bilirubin does not dissolve in water, even if there is a significant increase in blood in the urine analysis, there will be no deviations.

          The reasons for the increase in indirect bilirubin may be as follows:

          • congenital hemolytic anemia,
          • secondary hemolytic anemia (against a background of certain diseases such as lymphogranulomatosis , lymphocytic leukemia, rheumatoid arthritis, etc.),
          • medical hemolytic anemia, which are associated with the use of certain drugs (eg, aspirin, insulin, levomycetin, etc.),
          • toxichemolytic anemia (biting of snakes, insects, poisoning with fungi, harmful substances - copper salts, lead, etc.),
          • infectious diseases (such as malaria, sepsis, typhoid fever),
          • syndromes Gilbert, Lucy-Driskola, Kriegler-Nayyar.

          Increased bilirubin in the urine occurs in diseases that are accompanied by damage to liver cells:

          • hepatitis,
          • liver injury,
          • liver cirrhosis,
          • metastatic liver damage, etc.

          Is it dangerous to raise bilirubin during pregnancy?

          Pregnant women often also experience an increase in bilirubin, and most often this is due to the so-called jaundice of pregnant women. The causes of this are divided into two groups:

          1. Pathology of pregnancy:

          • acute fatty liver,
          • toxicity of early pregnancy (excessive vomiting),
          • cholelithiasis (can lead to obstruction of the duct and mechanical jaundice),
          • intrahepatic cholestasis of pregnant women (begins in the 3rd trimester and lasts until the very birth, but then passes on independently; serve as an individual response to a high level of estrogen in a woman's blood),
          • increased bilirubin in eclampsia and pre-eclampsia.

          2. Concomitant diseases:

          • acute viral hepatitis (hepatitis A, B, C, D, E, cytomegalovirus, Epstein-Barr virus, etc. .),
          • chronic liver disease,
          • hemolytic anemia,
          • blockage of the bile duct,
          • some infectious diseases (eg malaria),
          • medicinal hepatitis (taking levomycetin, sulfanilomides, penicillins, etc.),
          • alcoholic hepatitis.

          Timely diagnosis of these diseases during pregnancy is very important, as they can threaten the life of the mother and child.

          If before the conception the woman led a healthy lifestyle, then a slight increase in bilirubin for neither her nor for the fetus does not represent any danger. Quite often the change in the analysis causes stress (the fear of expectant mothers), namely, it is dangerous for the development of the child.

          A large increase in the level of bilirubin in the blood can be the cause of jaundice, and the causes of this can be various liver diseases. However, it should be noted that significant deviations from the norm are extremely rare, and therefore all the fears of women, as a rule, are groundless. After childbirth, the mother's bilirubin quickly returns to normal, and at the same time a slight increase in it does not affect the development of the baby in utero.

          If violations of the level of bilirubin in the blood, after a thorough examination, you can accurately determine the cause and, if necessary, conduct adequate treatment. Biochemical analysis of blood allows you to establish the "culprit" of increasing bilirubin.

          However, it should be remembered that inadequate preparation for analysis, nervous overexertion, stress and malnutrition can significantly distort the real picture - change the indicators of analysis. This, in turn, can make the future mommy worry about the health of her crumbs, which will only worsen the situation.

          In addition to various reasons that can cause an increase in bilirubin, the growing fetus can provoke an increase in the bile pigment in the mother, and this is considered the norm. There is a similar because of excessive pressure on the liver and a complicated outflow of bile (but this is not critical). Whatever it was, but bilirubin is easily processed by the liver and is excreted outward along the bile ducts. With the difficult withdrawal of these substances (in rare cases), a small accumulation of pigment in the body occurs.

          What if I have increased bilirubin during pregnancy?

          Principles of treatment depend on the cause of increased bilirubin in the blood, and to identify the cause, first of all, you need to take a blood test.

          It is important to remember that it is necessary to prepare for the analysis:

          • several days before the analysis is taken from the menu, it is necessary to exclude fried, smoked, spicy, pickled and alcohol;
          • It is not desirable to go in for sports;
          • you should cancel taking medication;
          • Try to avoid stressful situations;
          • Dinner before 20. 00;
          • drink only plain still water;
          • donate blood on an empty stomach;
          • before the analysis itself - sit down and calm down.

          If from these recommendations something was missed or not fulfilled, and the result disappointed you, then retake the analysis, adhering to this time all the training requirements.

          The norm of bilirubin in pregnant women should be within the following limits:

          • direct - 0-7, 9 ?mol / l,
          • indirect - less than 19 ?mol / l,
          • total - 3, 4-17, 1 ?mol / l.

          The results of the analysis should be shown to a qualified specialist - a gastroenterologist, and he will already select the appropriate treatment that is usually prescribed for pregnant women.

          As a rule, these are:

          • pharmacological preparations,
          • diet or proper nutrition,
          • outdoor walks,
          • elimination of stressful situations,
          • observing the regime of the day and rest,
          • rejection of bad habits.

          As soon as the cause of the increase in bilirubin in the blood of a pregnant woman is identified, treatment begins:

          • If the cause lies in the natural destruction of red blood cells, then they affect the cause of hemolysis .
          • Even an insignificant change in the level of bilirubin already serves as a clinical symptom of a possible liver disease. But this is not a reason for worrying and worrying! To exclude dangerous diseases, you can conduct ultrasound examination of the liver and gallbladder. If it is stagnant bile, then you need to eliminate the cause of stagnation - and the indicators are normalized. In this case, in no case can not engage in self-medication, and the cleansing of the liver should be under the supervision of a specialist. This problem can be solved with the help of proper nutrition and bring the test results back to normal in a short time. It is strictly forbidden to resort to starvation as a treatment or to practice various mono-diets.
          • With hepatitis and cirrhosis of the liver, bilirubin in the blood rises tens of times, so a slight increase in it - not an occasion to invent "deadly" diagnoses.

          Be healthy!

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