January 21, 2020

Gallbladder disease is one of the top non-obstetric (not directly related to pregnancy & childbirth) causes for hospitalization in the first year after giving birth. The most common type of gallbladder disease is cholelithiasis, also called gallstones. Often gallstones are small and asymptomatic, but in 1-3% of postpartum women, they lead to hospitalization and the surgical removal of the gallbladder.

What are gallstones and how do they form?

Gallstones are hardened deposits in your gallbladder, which is a small organ underneath your liver that stores bile (the fluid that aids digestion). A healthy gallbladder releases bile into the intestine to help process the fat in your food.

During pregnancy, estrogen and progesterone levels are high. This can inhibit the gallbladder from contracting properly and releasing bile into the intestine. The estrogen also causes the concentration of biliary cholesterol in the bile to gradually increase throughout pregnancy, which may cause biliary sludge (a precursor to gallstones) and gallstones.

Gallbladder disease can also crop up 2-4 months postpartum, due to hormone changes and rapid weight loss.

Gallstones and biliary sludge are fairly common, especially during pregnancy or postpartum. Up to 30% of pregnant or postpartum women experience biliary sludge and 12% experience gallstones. However, they often have no symptoms and go unnoticed.

What are the risk factors?

While pregnancy (and being female) is a well-established risk factor, additional risk factors contributing to the formation of gallstones include:

• A high-cholesterol and high-fat diet
• Maternal age (40 or more)
• Being Native American or Hispanic
• Obesity
• A sedentary lifestyle
• Insulin resistance
• Losing weight very quickly
• Having liver disease, diabetes, or certain blood disorders like sickle cell anemia or leukemia
• A family history of gallstones

How to prevent them?

If you’re at risk of developing gallstones, some recommendations for preventing them include:

• Regular physical activity
• Eat a low-fat, high-fiber diet
• Try not to lose weight too quickly (no more than 2 lbs per week)

If you had gallstones during pregnancy, following this advice in the postpartum phase may help reduce the risk that they will recur.

Related: How to lose weight post-pregnancy in a safe and healthy way

What are the symptoms of gallbladder disease?

Sometimes gallstones have no signs or symptoms. If a gallstone blocks a duct (called biliary colic or gallstone attack), it may result in the following symptoms:

• Pain in the upper right part of your abdomen
• Pain in the center of your abdomen, just below your breastbone
• Pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting

Severe pain or fever may be a sign of a gallstone complication, so talk to your provider if you experience them.

Related: What causes postpartum back pain and how to fix it

When to be concerned?

Sometimes gallstones are asymptomatic and you don’t even know they’re there. In that case, they don’t typically require treatment. Also, in 60% of cases, the biliary sludge and gallstones disappear after childbirth, when estrogen levels decrease.

However, if they do cause symptoms, the recommended treatment is usually cholecystectomy, which is the removal of the gallbladder. The rate of hospitalization for biliary diseases is approximately 0.5% of all births, and nearly all hospitalizations include a cholecystectomy. For women hospitalized during pregnancy, the procedure is usually performed after delivery and pain medication may be prescribed in the meantime.

Sources:

Ko, Cynthia W. “Risk Factors for Gallstone-Related Hospitalization During Pregnancy and the Postpartum.” The American Journal of Gastroenterology 101 (2006): 2263-2268. Retrieved on January 15, 2020 from https://www.ncbi.nlm.nih.gov/pubmed/17032191

de Bari, Ornella & Wang, Tony & Liu, Min & Paik, Chang-Nyol & Portincasa, Piero & Wang, David. (2014). Cholesterol cholelithiasis in pregnant women: Pathogenesis, prevention and treatment. Annals of hepatology. 13. 728-45. 10.1016/S1665-2681(19)30975-5. Retrieved on January 16, 2020 from https://www.researchgate.net/publication/267273599_Cholesterol_cholelithiasis_in_pregnant_women_Pathogenesis_prevention_and_treatment

İlhan, M., İlhan, G., Gök, A., Günay, K., & Ertekin, C. (2016). The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center. Turkish journal of obstetrics and gynecology, 13(4), 178–182. doi:10.4274/tjod.65475. Retrieved on January 16, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558289/

Mayo Clinic. Gallstones. (2019). Retrieved on January 16, 2020 from https://www.mayoclinic.org/diseases-conditions/gallstones/symptoms-causes/syc-20354214