Over 25 million people in the US suffer from gallstones, and more than 65% of them are women (1). Gallstones or gallbladder problems could affect expectant mothers. But you need not worry as the condition will not cause any harm to your baby.
However, it causes discomfort and pain, and so it has to be treated in time. Continue reading this MomJunction post to know what gallbladder is, how it functions, and the gallbladder problems that may arise during pregnancy.
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 becomes 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 In Pregnancy?
- Estrogen hormone: In pregnancy, estrogen increases cholesterol secretion and progesterone reduces bile acid secretion, which ultimately causes bile to become supersaturated with cholesterol. Progesterone slows down gallbladder emptying, which promotes the formation of stones by causing bile to become stagnated. This increases the risk of gallbladder problems for pregnant women. Estrogen therapy increases the risk.
- Overweight: When there is more fat in the body, more estrogen is produced. Therefore, pregnant women are told to keep their weight in control for a healthy pregnancy.
- Diabetes: The incidence of gallstones and gallbladder problems was found in people with diabetes. Hence, diabetes needs to be in control when you are pregnant.
- Others: Some other factors responsible for the formation of gallstones or gallbladder diseases in pregnancy include family history, diet, and any problems with the gallbladder.
It is essential to observe your bodily changes for any symptoms of gallbladder problems in pregnancy to treat them in time.
What Are The Signs Of Gallbladder Problems In Pregnancy?
The following signs and symptoms indicate that you could be having gallbladder problems:
- 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)
- Intense itching
- Dark colored urine
- Loss of appetite
These signs could be due to one or more kinds of gallbladder problems in pregnancy that we see in the next section.
Types Of Gallbladder Problems During Pregnancy
There are different types of gallbladder problems that could result from infection, inflammation, and blockage:
If there are not enough bile salts or there is extra cholesterol, or if the gallbladder does not empty out its contents properly, they lead to the formation of hard stones or gallstones. Gallstones are usually composed of calcium bilirubinate, cholesterol and calcium carbonate (4).
The progesterone hormone produced during pregnancy causes the body’s muscular tissue to relax (5). Therefore, the bile slows down, leading to the development of gallstones and other infections such as inflammation of the gallbladder (cholecystitis).
You are at a greater risk of this condition as your body makes more estrogen during pregnancy. The increasing estrogen levels can raise cholesterol concentrations in the bile and reduce gallbladder contractions. The slowing down of the contractions is known as cholestasis (reduced flow of bile). It is sometimes referred to as extrahepatic cholestasis (that occurs outside the liver) and intrahepatic cholestasis or obstetric cholestasis (that occurs inside the liver).
This condition leads to complications such as meconium in the amniotic fluid (meaning the baby passes the stool before its birth), stillbirth and premature birth (5).
3. Biliary colic
Biliary colic occurs due to the blockage of the gall ducts. If the bile is not able to exit the gallbladder due to stones, it can cause inflammation or infection inside the gallbladder. Non-release of bile means the failure of fats to digest in the small intestine. This causes shooting pain in the upper abdomen and back, which may last for a few minutes to several hours. You may even have nausea and vomiting (6).
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 into sludgy goo, referred to as gallbladder sludge.
In some cases, sludge thickens and forms into gallstones. And in some, it just fades away. But if it remains persistent, the doctor may prescribe medications or go for the surgical removal of the gallbladder.
These can be detected by proper diagnosis.
Diagnosis For Gallbladder Problems
You may mistake the gallbladder disease symptoms like morning sickness that occurs in the first trimester. But if the symptoms remain beyond the first trimester, your doctor may perform an ultrasound to test for gallbladder problems (7).
- Blood tests: These tests are recommended when the gallbladder diseases are not so complicated. A high count of white blood cells is associated with an abscess, inflammation, ruptured gallbladder, or an infection. Additionally, liver function tests including enzymes, bilirubin, CRP, ESR, and lipase are also checked to determine gallbladder problems.
- Ultrasound scan: It is the most effective way to look for gallstones during pregnancy. The professional can get a good view of the bile duct and gallbladder, and even a minute issue can be detected.
- Computed tomography (CT): Any inflammation in the gallbladder or rupture of the gallbladder can be noticed through this procedure. However, it is avoided during pregnancy due to the exposure to radiation.
- Magnetic resonance imaging (MRI): This method helps the formation of gallstones, if any, without the risk of radiation.
Based on the problem detected, the doctor recommends the treatment method.
Treatment For Gallbladder Problems During Pregnancy
Minor concerns with gallbladder during pregnancy can be solved through non-surgical treatments, and the major ones would need surgical methods.
If you show signs of infection such as a low-grade fever, nausea, dark-colored urine and more, your doctor might prescribe antibiotics. Also if you have itching because of cholestasis, medications are given to lessen the itch, and the fetus is closely monitored until your delivery.
2. Fluid replacement:
Biliary colic condition may require hospitalization with intravenous fluid replacement to manage pain and dehydration. There’s no need to worry as you would be discharged in a couple of days.
1. Laparoscopic cholecystectomy:
Gallstones, which keep the bladder from emptying completely and develop an infection, require surgery. Though gallbladder surgery is not a recommended treatment during pregnancy, it is possible to safely remove it. This procedure is known as cholecystectomy, which involves removal of the gallbladder with the use of unique instruments and by making tiny incisions in the abdomen.
This is safe to perform in any trimester as per the guidelines shared of the SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) (8).
Another procedure, open cholecystectomy, done in the third trimester, requires a wide abdominal incision for the easy removal of the gallbladder without damaging the uterus.
2. Endoscopic treatment:
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 (8).
How To Prevent Gallbladder Problems In Pregnancy?
You can take note of the following things to prevent any gallbladder complications in pregnancy.
- Try to keep your weight in control. Eat right and avoid binge eating.
- Have a healthy routine and exercise every day. Yoga, walking, and stretching exercises can help. Keep your body fit and flexible to avoid health complications.
- If you have diabetes and possess high levels of triglycerides, there would be a greater risk of gallstones. Therefore, you should keep your diabetic levels under check.
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.
1. Limit your fat consumption
Fat foods trigger a reaction in the gallbladder, and the pain turns accurate if you have large gallstones. Therefore, limiting your dietary fat will 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 will 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 decrease gallbladder infection.
- 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 and deposits do 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, the condition known as cholecystitis. In rare cases, it can cause 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).
3. Do gallbladder problems recur after pregnancy?
Gallbladder problems will not appear for two to four months after delivery due to the changing levels in the pregnancy hormones. But sometimes, a few conditions can cause gallbladder diseases even after pregnancy.
- Changing levels of pregnancy hormones post-delivery.
- Rapid weight loss. When you lose fat quickly, the excess cholesterol remains in the bile causing 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, you should take enough rest, and abstain from physical work while recovering.
Before and during pregnancy, keep a check on your weight. This will help you treat any condition in time, thereby preventing you from any risks or complications. You need not worry about gallbladder conditions, as the chances of their occurrence are few and also, there is a cure for the problem.
Have something to share about gallbladder issues? Feel free to share your thoughts in the comment section below.
2. Abdominal pain in pregnancy gallstones; Mount Nittany Health
3. S. Al-Bayati and S. Kodayer; Gallstones in the group of Iraqi patients with type 2 diabetes mellitus; Saudi Medical Journal (2012)
4. G. E. Njeze; Gallstones; Nigerian Journalof Surgery (2013)
5. Cholestasis of pregnancy; Univesity of Rochester Medical Center
6. Biliary colic; Harvard Health Publishing
7. Gallstones and gallbladder disease; AACC Lab Tests Online
8. J. P. Pearl et al.; Guidelines for the use of laparoscopy during pregnancy; Sages.org