Gallstones, Vomiting & Pregnancy. Part 1

Q.How is a gallbladder attack or gallstone problem affected by pregnancy? I have a friend who has thrown up for eight months, and the doctors told her it was probably her gallbladder. They said gallbladder problems often occur during pregnancy. Why?

Jamie

A.Gallstones are very common in our society. It’s estimated that up to 30 percent of women over age 50 have gallstones. Stones cause problems by temporarily blocking the cystic duct leading out of the gallbladder, resulting in abdominal pain, nausea, vomiting and fever. These episodes, called biliary colic, often lead doctors to recommend removal of the gallbladder.

A. During pregnancy, a couple of factors increase a woman’s propensity to form gallstones. First, the hormonal milieu, with high levels of estrogen, leads to higher levels of cholesterol in bile. Bile is made by the liver and stored in the gallbladder between meals. The higher concentration of cholesterol leads to formation of microcrystals, which slowly grow to form larger stones in the gallbladder. Secondly, the gallbladder enlarges during pregnancy, becoming more flaccid and losing its ability to empty after meals. Again, hormonal changes (probably increased progesterone levels) are responsible for this. This decreased gallbladder activity leads to stagnation of bile and greater propensity to form stones in the gallbladder. Overall, about 30 percent of pregnant women develop gallbladder sludge — thick bile with small crystals, which can cause pain (biliary colic). Two percent of pregnant women develop actual gallstones, which are even more likely to cause pain. In most cases, the gallbladder can be removed after the pregnancy to prevent future episodes.

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