From the Guidelines

Jaundice in pregnancy is a significant concern that requires prompt investigation and management.

Jaundice, or hyperbilirubinemia, can result from various causes, including gestational liver disorders such as intrahepatic cholestasis of pregnancy (ICP), preeclampsia, and HELLP syndrome, as well as pre-existing liver diseases like hepatitis, autoimmune hepatitis, and cirrhosis 1.
The most common causes of jaundice in pregnancy vary by geography and demographics, but hepatitis, alcoholic liver disease, and biliary obstruction are among the leading causes 1.

Elevation in aminotransferases, bilirubin, or bile acids in pregnancy is abnormal and requires investigation 1.
The diagnosis of jaundice in pregnancy involves a detailed history, physical examination, and laboratory tests, including liver function tests (LFTs) and total serum bile acids (TSBA) 1.
Ursodeoxycholic acid (UDCA) treatment is recommended for women with ICP, as it protects against spontaneous preterm birth and may also protect against stillbirth 1.
Weekly monitoring of TSBA and LFTs is essential in women with ICP, and delivery is recommended by 39 weeks of gestation if TSBA levels are elevated 1.

Pre-pregnancy counseling is crucial for women with pre-existing liver disease to optimize their health and disease management prior to pregnancy 1.
Genetic testing should be considered in women with severe ICP or a family history of hepatobiliary disease 1.
Postpartum follow-up is essential to ensure that TSBA, ALT/AST, and bilirubin return to normal within 3 months of delivery, and to investigate for underlying liver disease if necessary 1.

From the Research

The most common causes of jaundice in pregnancy are gallstones, preeclampsia/eclampsia/HELLP, and intrahepatic cholestasis of pregnancy, as found in a study of 80,857 consecutive deliveries 2.
Viral hepatitis is no longer a common cause of jaundice in pregnant women in the US, according to a study published in 2017 2.
Other causes of jaundice in pregnancy include cholestasis of pregnancy, as reported in a case study of a 34-year-old woman in the 22nd week of gestation 3.

Disorders that cause elevated maternal bilirubin during pregnancy are associated with increased risk for the fetus, including stillbirths, fetal malformations, neonatal deaths, and small for gestational age births 2.
Prolonged fetal exposure to elevated serum bilirubin levels may not necessarily result in developmental or neurologic handicap, as found in a case study of an infant born to a mother with end-stage liver disease 4.
The maternal pre-pregnancy weight and gestational weight gain may have an effect on the newborn bilirubin levels, with babies born to mothers who gained more weight than the advised amount during pregnancy being at higher risk for neonatal jaundice 5.

Jaundice is a common problem affecting over half of all full-term and most preterm infants, and health care providers need to be familiar with the diagnosis and management of jaundice to prevent brain, vision, and hearing damage 6.
The treatment of choice for jaundice remains close observation and frequent feeding, followed by phototherapy, and finally exchange transfusion for severe or refractory cases 6.