The increase in hormone levels makes women prone to gall bladder pain during pregnancy. Although gallstones do not affect the baby directly, they may cause intense pain and discomfort. Thus, it is important to seek proper medical care and treatment immediately after diagnosis to avoid any future complications (1). In this post, we tell you about gall stones in expectant mothers, their causes, signs, diagnosis, treatment, and prevention techniques.
What Is A Gallbladder?
The gallbladder is a small organ located beneath the liver. It stores the extra bile produced by the liver to digest the fats. As the food moves from your stomach, the gallbladder releases the bile juice into the small intestine to digest the fats. Sometimes, bile stays in the gallbladder, hardens with time, and turns into gallstones. These stones could get into the duct and cause infection and pain (2). Pregnancy is a time when the gallbladder is vulnerable to gallstones.
What Causes Gallstones Or Other Gallbladder Diseases In Pregnancy?
Women are more likely to get gallstones or gallbladder diseases. During pregnancy, any of the following factors could be responsible for the condition (3)(4)(5).
What Are The Signs and Symptoms Of Gallbladder Problems In Pregnancy?
The following signs and symptoms may indicate that you could be having gallbladder problems:
Intense itching (most common symptom) Image: Shutterstock Nausea and vomiting Yellowing skin and eyes (jaundice) Severe pain in the upper right or middle part of the abdomen. It can be aching, cramping, sharp or dull) Light-colored stools Dark-colored urine Fatigue Depression Loss of appetite
It is essential to observe your bodily changes for any symptoms of gallbladder problems in pregnancy to treat them in time. These signs could be due to one or more kinds of gallbladder problems in pregnancy.
Types Of Gallbladder Problems During Pregnancy
There are different types of gallbladder problems that could result from infection, inflammation, and blockage, resulting in severe abdominal pain.
1. Gallstones
If there are not enough bile salts or there is extra cholesterol, or if the gallbladder does not empty out its contents properly, it could lead to the formation of gallstones, a condition that is also known as cholelithiasis. Gallstones are usually composed of calcium bilirubinate, cholesterol, and calcium carbonate (4)(6). The progesterone hormone produced during pregnancy could cause the body’s muscular tissue to relax. Therefore, the bile slows down, leading to the development of gallstones and inflammation of the gallbladder (cholecystitis) (5)(7). It can further increase the risk of the following conditions during pregnancy (8)(9):
Choledocholithiasis (gallstones in the bile duct) Cholangitis (inflammation of the biliary tract) Pancreatitis (inflammation of the pancreas)
2. Cholestasis
The slowing down or stop in the flow of bile is known as cholestasis (reduced flow of bile). Cholestasis in pregnancy is also called obstetric cholestasis or intrahepatic cholestasis of pregnancy (ICP), and it occurs due to the increased pregnancy hormones. It is sometimes referred to as extrahepatic cholestasis (that occurs outside the liver) and intrahepatic cholestasis or obstetric cholestasis (that occurs inside the liver). It usually occurs in the late second and third trimesters. Intense itching in the soles of feet and palms is a common symptom of cholestasis. You may also notice the following signs and symptoms:
Pale feces Dark urine Jaundice (yellow skin and eyes)
ICP is diagnosed when the total bile acids (TBA) or serum bile acids levels are at 10umol/L or above (10). Though it does not cause significant risk for maternal health, it is recommended that you get immediate medical help, since this may lead to complications such as meconium in the amniotic fluid (meaning the baby passes the stool before its birth), stillbirth, and premature birth (11)(12).
3. Biliary colic
Biliary colic is also called a gallbladder attack or gallstone attack. This is a sudden pain due to the blockage of the cystic duct. The flow of bile from the cystic duct to the liver can be blocked from gallstones or functional disorders of the biliary tract. Non-release of bile means the failure of fats to digest in the small intestine. It may occur after a heavy meal and frequently during the night. It is usually felt as shooting pain in the right upper abdomen and may radiate to the right shoulder and back, which may last for a few minutes to several hours. You may even have nausea and vomiting (13).
4. Gallbladder sludge/ Biliary sludge
It mostly happens when the gallbladder is filled with excess cholesterol and not enough bile. Bile is like a soap, which emulsifies fats so that they can be absorbed into the digestive tract. If there is not enough bile, the remaining fat turns sludgy too, referred to as gallbladder sludge. The primary symptom of gallbladder sludge can be abdominal pain, usually after a meal. Nausea, vomiting, and clay-like stools are other symptoms of biliary sludge. However, some may not have any symptoms. In some cases, sludge thickens and forms into gallstones. And in some, it goes on its own. Biliary sludge is a frequent finding in pregnancy and often disappears after delivery (14). But if it remains persistent, the doctor may prescribe medications. The surgical removal of the gallbladder is recommended if it causes severe biliary colic or complicates to cholecystitis, cholangitis, and pancreatitis (15)(16).
Diagnosis For Gallbladder Problems
You may mistake the gallbladder disease symptoms like morning sickness that occurs in the first trimester. Your doctor may perform an ultrasound to test for gallbladder problems (17). The following tests are also used to diagnose gallstones and other gallbladder diseases during pregnancy (18): Based on the problem detected, the doctor recommends the treatment method.
Treatment For Gallbladder Problems During Pregnancy
Clinical management of gallstones and other gallbladder problems in a pregnant woman can be based on gestational age, maternal and fetal benefits, and severity of symptoms. Though the relapse of gallbladder disease is high in the first trimester, conservative medical management is preferred during the first and third trimesters (19). Your doctor may often delay the surgical management of non-acute cases to the second trimester or until postpartum to reduce the risk of spontaneous abortion and premature birth(20). However, advanced surgical techniques may have improved outcomes than conservative management.
Non-surgical treatments
Conservative management may help relieve gallbladder pain and other symptoms of gallstones or other gallbladder diseases during pregnancy. This includes (19) (21) (22):
Use of intravenous fluids for dehydration Correction of electrolyte imbalance Bowel rest Narcotics for pain relief: NSAIDs are not recommended for pregnant women, so intravenous meperidine is preferred for analgesia Medication for itching: Ursodeoxycholic acid (UDCA) or ursodiol is given to reduce the itching. It helps to increase bile flow and dissolving of gallstones. Normal treatments for the itch, such as antihistamines or hydrocortisone creams, are not effective in relieving itch resulting from cholestasis. Broad-spectrum antibiotics to prevent infections Fat restricted diet
You may require a few days of hospitalization during gallstones and other gallbladder diseases. Your doctor will monitor the biophysical profile of the fetus, and the next step is decided based on maternal and fetal benefits and risks.
Surgical treatments
Surgical interventions in pregnancy should minimize fetal risks without compromising the safety of the mother and fetus. Your doctor may recommend surgical removal of the gallbladder (cholecystectomy) to relieve gallbladder pain and other symptoms if you have acute cholecystitis, acute biliary colic, or relapsing symptoms (19). The surgical techniques to manage gallbladder problems are:
1. Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy is the surgical removal of the gallbladder through smaller incisions using tubes like devices and cameras. It can also be beneficial to remove gallstones in the biliary tract causing pancreatitis in pregnant women. Laparoscopic surgery can be less painful and also aids faster recovery compared to open surgery(23)(24). According to the Society of American Gastrointestinal and Endoscopic Surgeons, pregnant women may undergo laparoscopic removal of the gallbladder in any trimester without an increased risk to mother or fetus. However, the decision of treatment varies based on maternal and fetal outcome (25).
2. Open Cholecystectomy
Open cholecystectomy is the surgical removal of the gallbladder through an abdominal incision. Though laparoscopic cholecystectomy is safe in all trimesters, open surgery may be recommended for pregnant women, especially those who are in the third trimester, because laparoscopic port placement and insufflation of abdominal cavity with gas may be difficult. However, few studies show that cholecystectomy in the third trimester increases the risk of preterm delivery and related complications, and it is recommended to operate in the postpartum period if possible to manage conservatively (26)(27).
3. Endoscopic Retrograde Cholangiopancreatography (ERCP)
Choledocholithiasis is the presence of gallstones in the common bile duct. These gallstones can be removed by ERCP (endoscopic retrograde cholangiopancreatography), a procedure in which a thin and flexible tube is run through your mouth to the opening of the common bile duct. It injects a dye, and a small camera at the end of the tube gives a better view of the stones. The stones are then removed through the tube. The abdomen is covered during this procedure so that the radiation will not harm the fetus. ERCP is considered safer and effective during pregnancy (28).
How To Prevent Gallbladder Problems In Pregnancy?
The following changes in lifestyle and diet may help you prevent gallstones and other gallbladder diseases in pregnancy (29). Your diet also plays a role in preventing gallbladder problems. Continue reading to know about it.
Gallbladder Diet During Pregnancy
Diet can play a major role in reducing the severity of gallbladder problems if you are already experiencing conditions such as gallstones. Nutrition and lifestyle changes may be beneficial to prevent obesity that increases the risk of gallstone formation. The following changes in your diet may reduce your risk for gallstones and other gallbladder diseases (30)
1. Limit your fat consumption
Fat foods may trigger a reaction in the gallbladder, and it could increase the pain. Therefore, limiting your dietary fat may alleviate gallstone symptoms. For instance, choose light meat and skinless poultry instead of red meat, and low-fat yogurt in place of cooking oils. These modifications in the diet may lower the risk of a gallbladder attack and help you maintain a healthy weight.
2. Consume more fiber
Eat whole grains, fruits, and vegetables. They assist in the digestion process and may decrease gallbladder infection. The following foods may add more fibers to your diet:
Eat four to five cups of fruits or veggies every day Use vitamin-rich veggies such as tomatoes and baby spinach in the sandwich, instead of mayonnaise or cheese Add a handful of dried apricots to a cup of oatmeal Berries, broccoli, kale, and all dark-colored fruits and veggies are good options
3. Hydrate yourself
Drink plenty of water. Keeping yourself hydrated helps flush away toxins and unwanted residues from the body. It also improves digestion. However, avoid sweetened beverages and sodas as they contain extra calories. Instead, choose plain water with a twist of lemon.
4. Eat whole foods
Fresh and whole foods are healthy alternatives to processed and refined foods.
Eliminate highly processed foods containing trans fats, preservatives, and other additives Avoid packaged items such as crackers, chips, and cakes Try making your snacks such as fruit or vegetable slices, sandwich, and sprouts
In the next section, we have some common questions answered for you.
Frequently Answered Questions
1. Can gallstones harm my unborn baby?
Though gallstones may not directly affect the baby, the consequences of the disease could do. If you experience pain in the gallbladder for more than five hours, or severe symptoms of inflammation, infection, nausea, and vomiting, they will restrict you from having nutritious food, thus hampering the baby’s growth.
2. What can happen if gallstones are not treated?
Gallstones may cause spells of gallbladder pain if not treated in time. They also lead to inflammation of the gallbladder, also known as cholecystitis. In rare cases, it can become infected and lead to an abscess. If the gallstones block the bile duct, resisting bile flow from the liver, it can lead to jaundice. They may also affect the release of pancreatic juices, causing pancreatitis (inflammation of the pancreas)(9).
3. Do gallbladder problems recur after pregnancy?
Gallbladder problems may not appear for two to four months after delivery due to the changing levels in the pregnancy hormones. But sometimes, rapid weight loss after delivery may result in excess cholesterol, and it could increase the risk of gallstones.
4. Is pregnancy possible after gallbladder removal?
Yes, you can get pregnant after the surgical removal of the gallbladder. There are no complications if you conceive. However, it is recommended to take enough rest and abstain from physical work while recovering. You may have to follow dietary changes after gallbladder removal to avoid bloating and abdominal pain(32)
