A Guide to Gallstones During Pregnancy
The formation of gallstones is fairly common during pregnancy, primarily due to fluctuating hormone levels. Thankfully, only a small percentage of gallstones formed during pregnancy have symptoms that require treatment, and even those that do often have a positive prognosis.
What is a gallstone?
A gallstone is a collection of extra cholesterol and bile acids that form a stone in the gallbladder. During pregnancy, the risk of developing gallstones or sludge in the gallbladder rises due to the increased production of estrogen, which can lead to higher levels of cholesterol.
In addition, increased progesterone levels during pregnancy can slow down digestive system and gallbladder functions and increase reflux and constipation—which are also factors in gallstone formation.
The Journal of Midwifery & Women’s Health estimates anywhere from 3.5 to 10 percent of pregnant women can have asymptomatic gallstones. According to Alice K. Roberts, MD, OB/GYN physician at Abington – Jefferson Health, symptomatic gallstones affect less than one percent of pregnancies.
What are the symptoms?
The main symptom of gallstones is a pain in the upper right part of the stomach or ribs. In general, there are two different types of pain: biliary colic and cholecystitis.
Biliary colic occurs when a stone is blocking a bile duct. It can happen about an hour after eating a fatty meal as a result of a contraction around the stone. Cholecystitis is caused by inflammation of the gallbladder and is usually much more severe. This pain can move to the back and shoulder area and may last six hours or more.
Dr. Roberts says in many cases cholecystitis is an indication that the gallbladder should be removed. “It’s the second most common indication for non-pregnancy related surgery during pregnancy, behind appendix removal,” she says.
How are gallstones treated?
Treatment for gallstones during pregnancy depend on the symptoms. Most times they will remain asymptomatic or they will go away on their own. If you are experiencing cholecystitis, or repeated episodes of biliary colic, it’s likely that your doctor will recommend surgery to remove the gallstones or the whole gallbladder.
“Of women who have symptomatic gallstones, only about 10 percent will need surgery. Those who do have surgery, do very well. They are more comfortable than those who don’t have surgery,” says Dr. Roberts.
Surgery for gallstones can be done laparoscopically, with timing during the second trimester or early in the third trimester. These times have shown the best outcomes in studies, as the first trimester has greater risk of miscarriage or birth defects from medications used during surgery and the third trimester can be difficult because of the enlargement of the uterus.
Can gallstones be prevented?
There aren’t many confirmed methods of prevention for gallstones, although it’s commonly recommended to follow a low fat diet. Dr. Roberts says, “A lot of the risk comes from obesity and genetics.”
If you are experiencing continued pain that you suspect may be attributed to gallstones, it’s important speak with your doctor as they can advise you on the best course of treatment according to your individual situation.