Gallstones after pregnancy: What to know

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Pregnancy can lead to higher levels of certain hormones, such as estrogen, in the body, increasing the risk of developing gallstones.

The gallbladder is the body’s bile storage facility. It releases bile into the small intestine after meals to aid digestion. Bile is a fluid comprising cholesterol, bilirubin (a waste product of red blood cells), and bile salts. When these substances fall out of balance with each other, gallstones can form in the gallbladder.

The hormone increase due to pregnancy can raise cholesterol levels and delay gallbladder emptying. This occurs for many reasons.

One reason is that the liver may release more cholesterol in the bile if a person loses weight quickly, for example, following the delivery of a baby. This can also affect gallbladder function — specifically, it cannot empty properly.

Another reason may relate to the hormone progesterone. This can cause the gallbladder to relax and stops it from working properly.

A 2017 study found that having gallstones during pregnancy increased the risk of:

• preterm delivery, especially planned preterm delivery
• maternal disease
• maternal readmission to the hospital
• infant disease

However, having gallbladder surgery reduced the risk of the mother needing readmission to the hospital.

It is important to note that while almost 8 in 100 pregnant people develop new gallstones by the third trimester, only around 1 in 100 experience symptoms. Additionally, fewer than 10 in 100 people with symptoms develop complications.

Learn more about gallstones here.

Gallstones tend not to cause symptoms unless a stone blocks one of the biliary ducts. When this happens, a person may experience biliary colic, leading to sudden and severe abdominal pain.

The pain usually lasts 1–5 hours but sometimes disappears within minutes. It starts in the middle of the abdomen, just under the right-hand ribs, and it can spread to the side of the body or the shoulder blade.

Some people also experience excessive sweating, nausea, or vomiting. Doctors refer to this as uncomplicated gallstone disease.

If the blockage lasts longer or the gallstones travel into nearby organs, a person may experience other symptoms. In these cases, doctors call the condition complicated gallstone disease. Symptoms include:

• high temperature
• loss of appetite
• itchy skin
• diarrhea
• more persistent pain
• rapid heartbeat
• chills or shivering
• jaundice (yellowing of the skin and whites of the eyes)
• confusion

After delivering a baby, a person may have an increased risk of developing gallstones. Other risk factors include:

• being female, particularly if they have already had children
• being over 40 years old
• having a close family member with a history of gallstones
• having obesity or being overweight
• taking the antibiotic ceftriaxone (Rocephin)

People may also have an increased risk if they are living with the following conditions:

• cirrhosis, which leads to liver scarring due to long-term damage
• Crohn’s disease, a chronic inflammatory disease of the digestive system
• irritable bowel syndrome (IBS), another chronic inflammatory condition of the gut
• obstetric cholestasis, a pregnancy-related liver problem that can increase bile acid production
• primary sclerosing cholangitis, a type of bile duct disease

A diagnosis of gallstones may require abdominal imaging. Ultrasounds are safe for pregnant people.

If a person does not have symptoms relating to their gallstones, they may not need treatment. However, a doctor will want to keep monitoring them in case any symptoms develop.

People at increased risk of complications may need treatment. For instance, if they have:

• cirrhosis
• diabetes
• portal hypertension, or high blood pressure in the liver, due to alcohol-related liver disease
• elevated calcium levels in the gallbladder, which increases a person’s risk of developing gallbladder cancer

Treatment types depend on how the pain affects a person’s daily life. For mild and infrequent pain, doctors may recommend pain relievers and dietary changes.

Surgery

For more severe and persistent pain, doctors may recommend gallbladder removal surgery, or cholecystectomy.

Doctors typically perform laparoscopic cholecystectomy, a minimally invasive surgery, in the second or early third trimester. For more serious complications, doctors may opt to perform the surgery regardless of the trimester.

Some people can also manage their gallstones by taking ursodeoxycholic acid tablets to dissolve them. However, this medication only works on small stones that do not contain calcium and may not always be an effective treatment method.

Doctors also do not recommend ursodeoxycholic acid during pregnancy or breastfeeding.

Learn more about cholecystectomy here.

Does it go away on its own?

While eating a healthy diet can improve a person’s general health and help with gallstone pain management, it cannot cure gallstones or eliminate all symptoms. However, the longer a person with gallstones goes without symptoms, the less likely their condition is to worsen.

Some people may try natural remedies to eliminate gallstones, but there is limited evidence to suggest they work.

For milder issues such as bloating and diarrhea, a person can manage their symptoms by noting and avoiding any food triggers, such as fatty or spicy foods.

Some medications can help prevent gallstones but may not work well enough to dissolve already-formed stones. It is important for a person to talk with a doctor about taking any medications during pregnancy or breastfeeding.

Weight loss (if a person is overweight) and dietary changes can help to prevent gallstones in some people. However, there is limited evidence for these recommendations.

The United Kingdom’s National Health Service (NHS) recommends restricting foods with a high saturated fat content because cholesterol can play a role in gallstone formation. Foods that have a high-fat content include:

• butter, lard, and ghee
• cakes and cookies
• cream
• foods containing coconut or palm oil
• hard cheeses
• meat pies
• sausages and fatty cuts of meat

Instead, a person should focus on incorporating the following into their diet:

• whole grains
• plenty of fresh fruit and vegetables
• nuts — such as peanuts or cashews — as some evidence suggests they can help reduce the risk of gallstones forming

If a person is overweight, they can aim to lose weight gradually by making certain dietary changes and getting regular exercise. However, it is important to note that losing weight too quickly can cause imbalances in the bile constituents, subsequently increasing the risk of gallstone formation.

If a person thinks they may have biliary colic after pregnancy, they should make an appointment with their doctor. It may be necessary to seek advice from a doctor immediately if someone has any of the following signs or symptoms:

• jaundice
• abdominal pain for longer than 8 hours
• a high temperature and chills
• abdominal pain so severe that they are unable to get into a position that relieves it

When the constituents of bile, including cholesterol, bilirubin, and bile salts, become unbalanced, gallstones can form in the gallbladder.

During pregnancy, increases in the hormones progesterone and estrogen can affect cholesterol levels and delay gallbladder emptying. Both actions may increase the likelihood of developing gallstones and symptoms. These symptoms, such as abdominal pain, may develop rapidly in some.

Eating a diet high in fruits, vegetables, and whole grains and low in saturated fat may help to prevent gallstones. Many pregnant people who get gallstones do not experience symptoms. However, any new symptoms during pregnancy or following delivery may require a talk with a healthcare professional.