How Gallstones Are Treated During Pregnancy

Gallstones are concentrated lumps of a substance called bile, which is made up of water, fat, cholesterol, bilirubin, and salts. Bile is normally released into your small intestine, where it helps digest fats. However, bile can sometimes become concentrated and form gallstones.

In general, women are twice as likely as men to develop gallstones. During pregnancy, the odds are even higher. That's because the estrogen you produce during pregnancy can lead to higher cholesterol levels in your bile. As a result, about 5% to 8% of women will experience either gallbladder sludge or gallstones during pregnancy.

Gallstones may also form just after pregnancy due to hormonal changes and weight loss.

Symptoms and Diagnosis

Gallstones can cause significant symptoms including:

• Nausea
• Vomiting
• Sudden sharp pain in the upper right quadrant, which is the uppermost quarter of the right-hand side of your body (though pain may move depending on the stage of pregnancy)
• Fever
• Itching

It's important to note that not all women will experience the above symptoms with gallstones during pregnancy. In fact, some experience what's referred to as "silent gallstones" because they have no symptoms and don't receive a diagnosis until they've had medical imaging performed.

Blood work may not be as useful in pregnancy due to normal pregnancy changes. Instead, ultrasound is used to detect many cases of gallstones during pregnancy.

You may need to have testing done to figure out if your symptoms mean that you are, in fact, experiencing gallstones, as severe abdominal pain could also be a sign of round ligament pain or severe cramps (which, while uncomfortable, can be normal symptoms of pregnancy), or something more serious, such as a ruptured ectopic pregnancy or appendicitis.

As such, it's important to communicate this discomfort with your doctor to determine the root of the cause.

Untreated gallstones can lead to infection or cholecystitis (inflammation of the gallbladder), which can lead to a ruptured gallbladder. Treatment of cholecystitis often involves the removal of the gallbladder.

Treating Gallstones

While it's more common to manage gallstones in pregnancy with medicine, gallstones are the second-most common cause of surgery during pregnancy that isn’t pregnancy-related. About one in 1,600 women will have their gallbladder taken out due to gallstones in pregnancy.

Based on your symptoms and test results, your doctor may recommend that you have surgery to remove the gallstones or wait it out. Some doctors prefer to go ahead and operate because of the increased risk of a relapse, which can be worse. If you choose to wait it out, you may also be given medications for the pain. It is also often helpful to alter your diet:

• More fiber: Eat plenty of fiber-rich foods, such as fruits, vegetables, and whole grains.
• Good fats: Avoid saturated fats, such as those found in animal products (like meat and whole milk) and focus on omega-3 fatty acids and unsaturated fats.
• Fewer carbs: Limit intake of sugar and refined carbohydrates (like white bread and pasta).

First Trimester Treatment

Surgery is generally not recommended in the first trimester except in extreme cases. During the first trimester, there is a greater risk of birth defects from exposing your baby to the medications needed to perform surgery. If possible, surgery will be delayed until you have moved into the second trimester or until after you give birth.

Surgery had been thought to increase the risk of miscarriage, but new research indicates surgery for gallstone disease during pregnancy does not increase fetal or maternal mortality.

Second Trimester Treatment

Surgery is safest in the second trimester. It is also the easiest time to do the procedure with laparoscopy as opposed to an open incision, which is more complicated and requires a longer healing time.

Third Trimester Treatment

If you're in your third trimester, it's possible your doctor will encourage you to try to wait it out rather than have surgery because your growing uterus makes it more difficult to perform surgery using the laparoscopic technique. It is also more likely that you could experience preterm labor in the third trimester. Your doctor may also recommend that you have your gallbladder removed in the postpartum period.

A Word From Verywell

It's common to experience abdominal pain during pregnancy, and it could have many different causes. It's important to always discuss any pain and discomfort you're feeling with your provider, especially if it's accompanied by other symptoms that could be a sign of something more serious, such as gallstones.