Gallstones and Pregnancy: What Are the Symptoms and How Do You Manage Them?
Published on October 14, 2024
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Gallstones (cholelithiasis) are an important possible health condition to consider in pregnancy. Pregnancy is a direct risk factor for the development of gallstones, which are caused by imbalances in the gallbladder. Research suggests that about 12 percent of people experience them during pregnancy as well as postpartum.
Gallstones are relatively common, affecting about 10 percent of adults. But only 20 percent of these cases are large enough to cause problems and require further treatment. Symptomatic gallstones that require treatment happen in about 1 percent of pregnancies overall.
What Is a Gallstone?
A gallstone is a hard piece of digestive fluid, such as bilirubin or cholesterol. While often harmless and asymptomatic, these pebble-like materials can grow as large as a golf ball, and eventually block your bile ducts. Compared with men, women are more likely to develop gallstones, with pregnancy being a risk factor due to higher levels of estrogen.
Gallstone development is relatively common in pregnancy due to changes in hormones. The problem with gallstones during pregnancy is the potential for complications that can be harmful to both the mother and fetus. These include bile duct infection (cholangitis), jaundice, and pancreatitis, per Cureus.
Symptoms and Diagnosis of Gallstones During Pregnancy
If you are pregnant and are experiencing possible signs and symptoms of gallstones, it’s important to see a doctor right away. They can accurately diagnose gallstones and help you get the treatment you need to minimize complications to both you and your baby.
Signs of Gallstones
You may not experience any signs and symptoms of gallstones until they have grown large and have blocked your bile ducts. This is known as a “gallbladder attack,” which can then lead to an infection or severe inflammation of your gallbladder, pancreas, or liver. Notable signs and symptoms include:
- Pain in the upper part of your right abdominal area, which can develop after you eat and last for several hours
- A low-grade or high fever
- Chills
- Nausea
- Vomiting
- Dark urine
- Light-colored stools
- Yellowing of your skin or the whites of your eyes (jaundice)
Severe abdominal pain may indicate biliary colic, while the other symptoms may point to other serious health complications, such as gallbladder infection, pancreatitis, or biliary tree infection.
Diagnosis of Gallstones
To confirm the presence of gallstones, your doctor will ask you about your recent symptoms and order a series of tests. First, they will perform a physical exam and examine your abdomen for signs of pain. Next, they will order a blood test to look for elevated white blood cell counts (which can suggest an infection), as well as inflammation.
A doctor will also order imaging tests so they can get a better look at your gallbladder, pancreas, and liver. This will likely come in the form of an abdominal ultrasound or magnetic resonance imaging (MRI) instead of X-ray imaging, the latter of which may not be safe during pregnancy. Both ultrasound and MRI are considered painless and completely safe during pregnancy.
Causes and Risk Factors of Gallstones During Pregnancy
While there are specific causes and risk factors of gallstones more generally, there are some key differences to consider in cases that develop during pregnancy.
Causes
In general, gallstones may be caused by:
- Too much cholesterol in your bile
- Too much bilirubin in your bile
- Problems with your gallbladder, where it doesn’t empty bile as it should
- Increased estrogen levels, which naturally increase cholesterol
Risk Factors
Aside from increased estrogen and issues with your bile and gallbladder, there are certain risk factors of gallstones to consider during and outside of pregnancy. These may include:
Treatment and Management of Gallstones During Pregnancy
Treatment options for gallstones during pregnancy depend on the size of the gallstones, whether they are symptomatic, and the stage of pregnancy. The only way to get rid of gallstones is via surgical removal, though nonsurgical treatments for gallstones in pregnancy may also be considered.
Nonsurgical Treatment
For mild cases of obstructing gallstones in the bile ducts (the pipes that drain the gallbladder and liver), a doctor might recommend endoscopic retrograde cholangiopancreatography (ERCP), a procedure that directly removes stones stuck in your common bile duct. Other options include pain medications and intravenous fluids provided in a hospital setting. But in all these cases, surgery to remove the gallbladder may still be needed post-pregnancy to prevent future episodes.
Surgical Treatment
The only way to get rid of gallstones is by surgical gallbladder removal (cholecystectomy). An estimated 10 percent of pregnant women with symptomatic gallstones end up undergoing this minimally invasive procedure, and it is considered safe when timed correctly. That said, your doctors will not recommend a surgery while you are pregnant unless it is absolutely necessary.
Gallbladder surgery is best done during the second trimester, when possible miscarriage and birth defect risks are low compared with the first trimester. Surgical treatment is also sometimes performed in the third trimester, but in the earlier weeks before uterine enlargement. Yet if serious complications have developed and place your baby at risk, a doctor may recommend surgery regardless of the trimester.
Dietary Recommendations
While there’s no single diet for gallstones in pregnancy that can directly get rid of gallstones or prevent development of future ones, eating (and avoiding) certain foods can help you feel better while minimizing the risk of future gallstone formation. In general, it’s important to focus on a balanced diet with plenty of fiber but one that is also low in animal fats. Consider cutting back on or eliminating refined carbohydrates, sugary foods, and fried foods.
How to Prevent Gallstones During Pregnancy
While you may not be able to completely prevent gallstones, certain lifestyle changes can help. This is still true during pregnancy. Possible preventive measures may include:
- Regular exercise, with a focus on safe workouts during pregnancy such as walking or swimming
- Maintaining a healthy weight
- Regular meals and snacks throughout the day
The Takeaway
Gallstones in pregnancy are common because of changes brought on by elevated estrogen levels in your body. While they aren’t always problematic, symptomatic gallstones can indicate blocked bile ducts, a serious infection, or a related inflammatory condition. If you suspect you have a symptomatic gallstone, contact your doctor right away.
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Yuying Luo, MD
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Resources
- Rampersad FS et al. Choledocholithiasis in Pregnancy: A Case Report. Cureus. February 2022.
- Gallstones. Cleveland Clinic. January 15, 2024.
- A Guide to Gallstones During Pregnancy. Jefferson Health.
- Definition and Facts for Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. November 2017.
- Rampersad FS et al. Cholelithiasis in Pregnancy: A Case Report. Cureus. February 2022.
- Symptoms and Causes of Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. November 2017.
- Diagnosis of Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. November 2017.
- Guidelines for Diagnostic Imaging During Pregnancy and Lactation. American College of Obstetricians and Gynecologists. October 2017.
- Gallstones. Mayo Clinic. August 20, 2021.
- Celaj S et al. Gallstones in Pregnancy. Journal of the American Medical Association. June 15, 2021.
- Eating, Diet, and Nutrition for Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. November 2017.