Gallstones and Pregnancy: What You Need To Know

Pregnancy-related hormone surges can raise cholesterol and postpone the gallbladder's emptying, both of which can result in cholelithiasis in pregnancy. By the third trimester, over 8% of pregnant women develop new gallstones, but only around 1% of them experience symptoms. Less than 10% of those who exhibit symptoms go on to experience problems. Pregnancy and gallstones might provide special difficulties. For expectant mothers, it is essential to comprehend the warning signals, diagnosis, treatment, and prevention. The article will discuss more about gallstones and pregnancy.

Recognising Gallstone Symptoms in Pregnancy

People with gallstones during pregnancy have the same symptoms as those who are not pregnant, such as pain in the right upper area or centre of the abdomen (biliary colic). The main symptom of gallstones during pregnancy is pain in the upper part of the stomach and ribs. The pain can be constant or cramping, sharp or dull, and last for at least 30 minutes. It can also appear one to two hours after a high-fat meal.

Gallstones complications often exhibit symptoms such as:

• Upper abdominal pain: Commonly felt after meals, especially fatty ones.
• Nausea and vomiting: Particularly after consuming greasy or rich foods.
• Back pain between shoulder blades: Radiating from the upper abdomen.
• Indigestion or heartburn: Persistent discomfort even with antacids.
• Jaundice: Yellowing of the skin or eyes in severe cases.

Other symptoms of gallstones during pregnancy include:

• Fever
• Yellowing of skin and whites of the eyes (jaundice)
• Nausea
• Ongoing vomiting
• Light-coloured stools
• Dark urine

More serious complications can cause more severe symptoms. Symptomatic gallstone disease in pregnancy can increase the risk of mortality for both the mother and foetus. Complications can include Spontaneous abortion, Foetal abnormalities, Preterm labour, and Death.

Diagnostic Methods for Detecting Gallstones in Pregnancy

The most common method for diagnosing gallstones during pregnancy is abdominal imaging, usually an ultrasound. Ultrasounds are safe during pregnancy and are highly sensitive to gallstone detection. Several tests help identify gallstones:

• Ultrasound: Safe imaging technique commonly used during pregnancy to visualise gallstones.
• Blood tests: Assessing liver function and checking for increased bilirubin levels.
• Cholescintigraphy (HIDA scan): Utilised when ultrasound results are inconclusive.

Other imaging techniques for pregnant patients include:

• Magnetic resonance
• Magnetic resonance cholangiopancreatography

Ultrasound uses a transducer to bounce sound waves off organs to create an image. Gallstones will appear in the image. Blood work may not be as useful during pregnancy due to normal pregnancy changes.

Managing Gallstones During Pregnancy

Pregnant women with biliary colic should avoid eating or drinking until the attack subsides. Pain medications and intravenous fluids may be given in the hospital to help with symptoms. If biliary colic does not resolve with these measures, cholecystectomy should be considered. Handling gallstones in pregnancy requires caution due to limitations. Treatment options include:

• Pain management: Using safe medications or non-pharmacological methods to alleviate discomfort.
• Dietary adjustments: Low-fat diets may help reduce gallbladder stimulation and pain.
• Hospitalisation: In severe cases, observation and pain management might be necessary.
• Surgery: Rarely performed during pregnancy but considered in emergencies or complications.

Pregnant women with gallstones are monitored closely. Gallstones are more common in pregnant women. However, pregnancy doesn't increase the risk of complications from gallstones. Treatments for Gallstones during pregnancy usually depend on the symptoms. Most of the time, gallstones are asymptomatic or go away on their own. If a gallstone blocks the gallbladder or causes an infection, surgery may be necessary. Surgeons recommend laparoscopic cholecystectomy for all pregnant women with symptomatic gallstones. This procedure is usually safe for the mother and the foetus. Symptoms of gallstones include:

• Severe pain called biliary colic
• Pain that's worse than child labour, a heart attack, or breaking a leg

Gallstones are diagnosed by abdominal imaging, most commonly ultrasound. Ultrasound is safe during pregnancy.

Preventing Gallstones During Pregnancy

Foods high in saturated fat tend to increase the formation of gallstones, whereas monounsaturated and omega-3 fats assist in preventing them. Changes in lifestyle are part of preventive measures. Prevention of gallstones can be done in the following ways:

• Healthy eating: Emphasise low-fat, high-fibre foods and regular meals.
• Hydration: Drinking plenty of water helps prevent gallstone formation.
• Gradual weight management: Avoid rapid weight loss strategies during or after pregnancy.
• Regular physical activity: Aids in weight management and overall health.

There aren't many confirmed ways to prevent gallstones during pregnancy. However, some things you can try include:

• Low-fat diet
• Healthy weight gain
• Fibre-rich foods
• Avoiding saturated fats

Hormonal changes during pregnancy increase the risk of gallstones in women. Elevated hormones can lead to delayed gallbladder emptying and elevated cholesterol. Notifying your doctor of any gallbladder issues is a good idea. For expectant mothers who have symptomatic gallstones, the Society of American Gastrointestinal and Endoscopic Surgeons advises laparoscopic cholecystectomy.

Pregnancy After Gallbladder Removal

It appears safe to become pregnant any time following appendectomy and cholecystectomy, but, probably depending on the indication, attention should be paid 0–11 months after diagnostic laparoscopy. For individuals who've had gallbladder removal before pregnancy:

• Most pregnancies proceed normally without complications related to prior gallbladder issues.
• Some digestive changes might occur, necessitating dietary adjustments during pregnancy.

According to a study, it's safe to conceive after cholecystectomy. However, another study found that women who had their gallbladder removed during pregnancy experienced:

• Longer hospital stays
• Increased 30-day readmissions
• Higher rates of preterm delivery

A study from the American College of Surgeons found that women who had gallbladder surgery during pregnancy experienced worse complications, such as Eclampsia (seizures, Bleeding, and Preterm delivery. Some studies support that laparoscopic cholecystectomy can be safely performed during pregnancy. However, the consensus is to delay surgical procedures until after delivery.

Pregnant women are more likely than nonpregnant women to develop gallstones. Gallstones can form as a result of pregnancy because during pregnancy, the hormones progesterone and oestrogen increase in the body. During pregnancy, gallstones can lead to inflammation and the development of cholestasis. The most common cause of this is insufficient bile release. So, it is important for pregnant women to go through regular checkups and discuss any discomfort they might feel with their doctor.