Gallstones in Pregnancy
Gallstones can develop at any age and affect both men and women, though the risk is higher for women by 2 to 3 times, and even higher if the woman is pregnant. One key reason for this is that women produce more oestrogen during pregnancy, which leads to higher amounts of cholesterol in the bile, thereby resulting in the formation of gallstones.
Symptoms and Complications
Gallstones in pregnancy have similar symptoms and complications regardless whether one is pregnant or not. These include:
- abdominal pain, specifically in the right upper abdomen
- persistent abdominal pain, bloatedness and indigestion
- nausea and vomiting
- light - or clay-coloured stool, tea- coloured urine
- fever, chills or rigors
- yellowing of the eyes and skin (jaundice)
Diagnosis and Treatment
Gallstones during pregnancy are diagnosed via abdominal imaging tests such as an ultrasound. When it comes to treatment, women with gallstones while pregnant are treated based on how far along in their pregnancies they are.
- First-trimester treatment: Surgery is not recommended as a treatment for gallstones during the first trimester unless absolutely necessary. This is because surgery and anaesthesia during this period can increase the risk of low birth weight infants and miscarriage.
- Second-trimester treatment: The second trimester is the safest time to perform gallbladder surgery if it is necessary. Doing the procedure laparoscopically is preferred because it is easier and safer compared to a traditional open surgery, which requires a long incision and longer recovery.
- Third-trimester treatment: At this stage, surgery is not recommended. Instead, the recommendation will be for the woman to first deliver her baby before gallbladder surgery is scheduled. Reasons are there is increased risk of preterm labour and laparoscopic surgery is more difficult to perform with a gravid uterus. If a Caesarean section is planned, if it is appropriate and necessary, the surgery can be performed at the same setting after the baby is delivered.
If it is necessary for emergent surgery, the treatment will be managed by a multidisciplinary team including the patient’s obstetrician, the gallbladder specialist surgeon and a neonatologist, to ensure the best care and optimal safety for all.
Gallbladder pain during pregnancy can be addressed by taking medicine as prescribed and practicing general care as outlined below.
Medicines: Pregnant women can experience pain and other complications if their gallstones are symptomatic. This can be addressed by taking certain medications advised by their healthcare provider. Instructions on how to take these medicines should be followed to minimise symptoms and complications as well as ensuring it is safe for the pregnancy and foetus.
General Care: Hormones, hereditary conditions, and genetics are some of the risk factors for gallstones that cannot be controlled. However, patients can opt for lifestyle changes that can aid in lessening symptoms. These can include:
- Maintaining a healthy weight and balanced diet
- Consuming food that are high in fibre and low in fat
- Avoiding fried and greasy food, minimising high-fat food such as red meats, animal fats
- Engaging in appropriate physical exercise
- Drinking plenty of water
- Limiting consumption of food that are high in sugar and carbohydrates
- Going to regular health check-ups or seek medical attention early if symptoms occur
Will gallbladder disease affect my baby?
Gallstones can be asymptomatic and will not directly affect the baby. However, if a pregnant woman has symptomatic gallstones that affects how she eats, or that cause inflammation or infection, then the condition may cause health problems for the baby.
After a gallbladder surgery, is it safe for breast feeding?
Yes, it is deemed to be safe. Patients should resume breastfeeding as soon as possible after surgery because anaesthetic drugs appear in very low and safe levels in breastmilk. In the past, conventional and conservative advice had patients “pump and dump” for period of 4-24 hours due to other considerations or medications that may be on-board, such as pain-killers, antibiotics. To be safe and sure, do seek your doctors’ advice before commencing on breast feeding.
Gallbladder disease after pregnancy
After giving birth, if the gallstones are causing symptoms or had resulted in complications before, it is advisable to consider gallbladder surgery to remove the unhealthy gallbladder and the stones within early.
Surgical Associates offers personalised and effective services for the treatment of gallstones during pregnancy. The clinic also provides treatments for gallbladder issues after pregnancy. For more information, call 6454 0054 or visit www.gallstones.sg.