What is cholelithiasis during pregnancy?
Cholelithiasis is the presence of gallstones, which usually are made of cholesterol or bilirubin. Gallstones grow and accumulate because of hormonal changes and because the movement of bile is slowed in the system of ducts that connects the liver, gallbladder, and small intestine (biliary sludge). Although many people have some amount of cholelithiasis, the stones are not always big enough to cause problems, or in a location to cause problems even if they are big. However, since pregnancy stimulates gallstone buildup, repeated pregnancies increase your chances that obstruction will occur in the cystic duct (the duct that joins with the hepatic duct that leads out of the liver), leading to cholecystitis (inflammation of the gallbladder) and/or inflammation of the duct (cholangitis). It also can cause other problems, including obstruction of the pancreatic duct, leading to pancreatitis.
How common is cholelithiasis during pregnancy?
Cholelithiasis is present in 10-15 percent of the adult population in developed countries, while biliary sludge is reported to develop in 5 to 30 percent of women. Women of reproductive age are 2-3 times more likely than men to develop cholelithiasis, but the prevalence of the condition varies widely between different countries and ethnic groups. Apart from female gender and pregnancy, major factors that promote gallstone formation include obesity, metabolic syndrome, and low concentrations of high-density lipoprotein (HDL, good cholesterol) in the blood.
How is cholelithiasis during pregnancy diagnosed?
Cholelithiasis can be diagnosed by detecting gallstones with imaging procedures, such as abdominal ultrasound, endoscopic ultrasonography (EUS – ultrasound through a special tube inserted through your throat), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). Other imaging tests that can detect gallstones include hepatobiliary iminodiacetic acid (HIDA) scanning and computerized tomography (CT). Doctors tend to avoid these latter two procedures during pregnancy, as they expose you to ionizing radiation, but the effective radiation dose from a HIDA scan is just 2.5 millisievert (mSv), which is the only dose that is considered a safe limit for a pregnant woman who is exposed to radiation at work.
Does cholelithiasis cause problems during pregnancy?
Cholelithiasis can lead to cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). These conditions cause severe upper abdominal pain, often with fever and chills. These conditions can be acute (intense, developing over a short time) or chronic (less intense and waxing and waning over months to years). Particularly with acute cholecystitis, if not treated, an infection can destroy and rupture the gallbladder and spread to other organs, which can be fatal, while chronic cholecystitis can lead to gallbladder cancer. Stones lodged in the pancreatic duct can cause pancreatitis, which also can be acute (with pain and potentially life-threatening complications) or chronic, with both acute and chronic pancreatitis increasing the risk of pancreatic cancer.
Does cholelithiasis cause problems for the baby?
If complications develop that give you a fever and you dont treat it, this can increase a babys risk of having congenital defects involving the heart and other organs. If you develop severe complications, such as gallbladder rupture, then the baby is at risk, because your life is at risk.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the cholelithiasis
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat cholelithiasis during pregnancy?
When cholelithiasis has not produced complications, such as cholecystitis, typically, no medications or other treatment are provided. Very often, people with cholelithiasis dont even know that they have it, unless/until it does cause a duct obstruction, producing abdominal pain. In cases when gallstones are discovered, and they havent blocked anything, your doctor will tell you to be aware of the condition and to come in to be checked if you do develop abdominal pain. If the cholelithiasis leads to cholecystitis, in many cases, you will be treated with conservative management, meaning that you take antibiotics and pain medication while your condition is monitored. This often is a favored option for acute cholecystitis during pregnancy, since the alternative is surgery. Antibiotics also are needed in many cases of cholangitis, but many cases of pancreatitis do not require antibiotic treatment. Because there are a large number of categories of antibiotics and pain medications, there are medical regimens that are considered safe for pregnancy.
Who should NOT stop taking medication for cholelithiasis during pregnancy?
As mentioned above, medications (antibiotics and pain medication) are given only in cases of complications of cholelithiasis, such as cholecystitis. It is very important NOT to stop taking antibiotics without consulting with your physician. If you react to a particular antibiotic, a different antibiotic can be substituted, but you need to be on the same page as your doctor with this. Pain medications can be adjusted in consultation with your physicians.
What should I know about choosing a medication for my cholelithiasis during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for cholelithiasis when I am breastfeeding?
As mentioned above, medications (antibiotics and pain medication) are given only in cases of complications of cholelithiasis, such as cholecystitis. Because there are a large number of categories of antibiotics and pain medications, there are medical regimens for cholecystitis that are considered safe in nursing mothers.
What alternative therapies besides medications can I use to treat my cholelithiasis during pregnancy?
Uncomplicated cholelithiasis does not require treatment, but you can slow the growth of gallstones, thereby lowering the risk of complications by losing weight if you’re obese, and taking measures to increase the concentration of HDL cholesterol in your blood by engaging in exercise. You can also include sources of monounsaturated fats, such as fish and olive oil in your diet, and quit smoking.
What can I do for myself and my baby when I have cholelithiasis during pregnancy?
It is very important to follow the instructions of your physician and avoid controllable risk factors for gallstone disease, such as smoking and a sedentary lifestyle.
Resources for cholelithiasis in pregnancy:
For more information about
cholelithiasis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: