It is possible to become pregnant while having gallstones. Gallstones are hardened deposits of digestive fluid, typically formed from cholesterol or bilirubin, that develop in the gallbladder, a small organ located beneath the liver. While many people with gallstones have no symptoms, pregnancy significantly increases the risk of developing new stones or worsening existing ones.
Pregnancy is an important risk factor for gallstone disease due to hormonal shifts. Research suggests that 3.5% to 12% of pregnant women may have asymptomatic gallstones or biliary sludge, with symptomatic cases affecting about 1% of pregnancies. The physiological changes during pregnancy require careful monitoring and management for the health of the mother and fetus.
The Hormonal Link: Why Pregnancy Aggravates Gallstone Risk
The two primary hormones of pregnancy, estrogen and progesterone, directly influence gallbladder function. Elevated estrogen levels cause the liver to secrete bile highly saturated with cholesterol. This supersaturated bile composition promotes the crystallization and formation of cholesterol gallstones.
Progesterone relaxes smooth muscles, which slows the rate at which the gallbladder contracts and empties bile, a condition known as stasis. The combination of cholesterol-thickened bile and sluggish emptying creates an ideal environment for stones to form and grow.
The gallbladder’s volume also tends to double during pregnancy, while its emptying rate decreases significantly. These changes are most pronounced during the second and third trimesters when hormone levels are highest. This physiological slowdown, coupled with the altered bile composition, explains why many women begin to experience painful symptoms during pregnancy.
Potential Complications for Mother and Fetus
When gallstones become symptomatic, they can lead to acute medical conditions posing risks to both the mother and the fetus. The most common symptom is biliary colic, which is severe pain in the upper right abdomen occurring when a stone temporarily blocks a bile duct, often triggered after a fatty meal. A prolonged blockage can cause Acute Cholecystitis, leading to inflammation and infection of the gallbladder wall that requires immediate medical attention.
A stone traveling further down the biliary system can block the common bile duct or the pancreatic duct, resulting in jaundice or Biliary Pancreatitis. Gallstone pancreatitis is associated with a fetal loss rate that may be as high as 10% to 20% if not managed effectively. These complications often require hospitalization for pain management, intravenous fluids, and antibiotics to control infection.
Severe maternal illness, infection, and inflammation are the main threats to the fetus. A systemic infection from acute gallbladder disease can trigger adverse outcomes such as preterm labor and delivery or low birth weight. Managing the maternal condition is therefore paramount to protecting the developing baby, as unresolved infections or complications increase the overall risk to the pregnancy.
Safe Management and Treatment During Pregnancy
The initial management for symptomatic, uncomplicated gallstones during pregnancy is conservative, focusing on reducing symptoms without surgery. Dietary modifications are a primary approach, involving a low-fat diet to minimize the need for the gallbladder to contract and expel bile. Adequate hydration and safe pain relief options, such as acetaminophen, are used to manage episodes of biliary colic.
For diagnosis, ultrasound imaging is the preferred tool because it is quick, highly effective at detecting stones, and avoids ionizing radiation exposure for the fetus. If more complex imaging is required to check for stones in the bile duct, Magnetic Resonance Cholangiopancreatography (MRCP) is often used, as it also does not involve radiation. Should a stone cause a severe complication, such as common bile duct obstruction, an endoscopic procedure called an ERCP can be performed with specialized precautions.
When symptoms are recurrent or the mother develops acute complications like cholecystitis, surgical removal of the gallbladder, called laparoscopic cholecystectomy, may be recommended. The second trimester is the safest window for non-obstetric surgery, as the risk of miscarriage is lower than in the first trimester, and the risk of premature labor is lower than in the third. If the condition is an emergency, surgery can be safely performed in any trimester, but postponing necessary intervention can lead to higher complication rates.