How Gallbladder Pain and 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. Here's what to know about gallbladder pain during pregnancy and how gallstones are diagnosed and treated during pregnancy.

Developing gallstones during pregnancy or the postpartum period is fairly common. Rapidly changing hormones during these periods can lead to the development of gallstones, sometimes causing gallbladder pain and occasionally the need for surgery.

People assigned female at birth are twice as likely as people assigned male at birth to develop gallstones. During pregnancy, the odds are even higher. That's because the estrogen the body produces during pregnancy can lead to higher cholesterol levels in your bile. As a result, nearly 8% of pregnant people will develop gallstones by the third trimester.

Common Symptoms of Gallstones

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 people will experience these 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. Others may experience a "gallbladder attack" when a blockage of bile leads to a buildup of pressure in the gallbladder, causing severe abdominal pain.

How Gallstones Are Diagnosed During Pregnancy

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

Testing and correct diagnosis are especially important because abdominal pain during pregnancy could also be a sign of a less worrisome condition like round ligament pain or something more serious, such as a ruptured ectopic pregnancy or appendicitis.

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.

How to Treat Gallstones During Pregnancy

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 1 in 1,600 pregnant people 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.

First trimester gallstones treatment

Surgery is generally not recommended in the first trimester except in extreme cases. During the first trimester, there is a greater risk of congenital disorders 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 gallstones treatment

Surgery is typically 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 gallstones 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 after delivery.