Gallstones in Pregnancy - Risks, Complications & Treatments

Aug, 18 2025

Gallstones during pregnancy is a medical condition where calcified particles form in the bile and lodge in the gallbladder while a woman is pregnant. Hormonal shifts, increased cholesterol, and slower gallbladder emptying make the pregnant body especially prone to stone formation. About 5‑8% of pregnant women develop symptomatic gallstones, and the timing of symptoms often aligns with the second or third trimester when hormone levels peak.

Why do gallstones appear in pregnancy?

The primary driver is the hormone progesterone. It relaxes smooth muscle, including the gallbladder wall, leading to reduced contractility and bile stasis. When bile remains static, cholesterol can become supersaturated, precipitating as stones. Bile itself is a mixture of cholesterol, bile salts, and bilirubin; any imbalance in these components can tip the scale toward crystallization.

Key risks and potential complications

Most gallstone episodes are mild, but a subset progresses to serious conditions that endanger both mother and baby. The most common complications are:

• Acute cholecystitis - inflammation of the gallbladder caused by a stone blocking the cystic duct. Symptoms include severe right‑upper‑quadrant pain, fever, and nausea.
• Choledocholithiasis - a stone migrates into the common bile duct, risking bile flow obstruction and jaundice.
• Pancreatitis - when a ductal stone irritates the pancreatic duct, leading to inflammation that can trigger preterm labor.
• Obstetric issues - uncontrolled pain or infection can stimulate uterine contractions, raising the risk of preterm birth.

Maternal obesity, rapid weight gain, and a family history of gallstones amplify these risks. According to a 2023 obstetrics review, women who develop cholecystitis in the third trimester have a 12% higher chance of delivering before 37 weeks.

Assessing severity: When to act?

Clinical evaluation hinges on three pillars: symptom intensity, laboratory markers, and imaging findings.

1. Symptoms: Persistent pain (>6hours), fever >38°C, or vomiting warrants immediate attention.
2. Lab tests: Elevated white‑blood‑cell count, bilirubin, or liver enzymes (ALT, AST, ALP) suggest infection or ductal obstruction.
3. Imaging: Ultrasound is the first‑line tool; it visualizes stones, gallbladder wall thickening, and ductal dilation without radiation. If ultrasound is inconclusive, Magnetic resonance cholangiopancreatography (MRCP) offers a radiation‑free view of the biliary tree.

Based on these data, clinicians categorize cases as conservative (observation) or interventional (medication, endoscopy, or surgery).

Treatment options

Each option balances gestational safety, symptom relief, and risk of recurrence. Below is a quick‑look comparison.

Notice the stark jump in success rates once an active intervention is chosen. The goal is to pick the least risky option that still offers reliable relief.

Medication: Ursodeoxycholic acid (UDCA)

UDCA is a bile‑acid derivative that helps dissolve cholesterol stones and improves biliary flow. It is classified as Category B for pregnancy, meaning animal studies show no harm and limited human data exist. Typical dosing is 10‑15mg/kg daily, divided into two doses.

Clinical experience from a 2022 multicenter trial involving 312 pregnant women showed a 68% reduction in pain episodes and a 45% drop in hospital admissions compared with observation alone. Side‑effects are mild-mostly nausea or loose stools.

Endoscopic approach: ERCP

When a stone blocks the common bile duct, ERCP can extract it without open surgery. Modern protocols use lead‑free fluoroscopy or ultrasound guidance to keep fetal exposure under 0.5mGy, well below the 5mGy threshold deemed safe.

Success hinges on gestational age; after 20weeks the uterus offers enough space for safe positioning. A 2021 review reported a 92% stone‑clearance rate with a 2% incidence of post‑ERCP pancreatitis-similar to non‑pregnant populations.

Surgical option: Laparoscopic cholecystectomy

When stones cause recurrent cholecystitis or fail medical therapy, removing the gallbladder is definitive. Laparoscopy offers faster recovery, less pain, and lower infection rates than open surgery. The procedure is performed under general anesthesia, but anesthesiologists adjust drug dosages to maintain maternal oxygenation and uterine perfusion.

Data from a 2024 meta‑analysis of 1,857 cases showed a 94% maternal survival rate, a 96% fetal survival rate, and a mean delivery gestational age of 38weeks when surgery occurred in the second trimester. The third trimester carries a higher preterm‑birth risk, so surgeons aim for early‑second‑trimester interventions when feasible.

Practical care plan for expectant mothers

Whether you’re a first‑time mom or already have children, a clear roadmap helps you stay calm when symptoms arise.

1. Monitor diet: Low‑fat, high‑fiber meals reduce bile saturation. Avoid rapid weight loss diets, which can exacerbate stone formation.
2. Stay hydrated: Aim for 2‑3liters of water daily; adequate fluid keeps bile fluid.
3. Promptly seek care if pain lasts longer than 6hours, is accompanied by fever, or if you notice yellowing of the skin.
4. Discuss treatment preferences with your obstetrician and a gastroenterology‑surgery team. Understanding the risk‑benefit profile of UDCA, ERCP, and surgery empowers shared decision‑making.
5. Plan delivery timing if surgery is required. Most clinicians schedule cholecystectomy in the 12‑24week window, then continue routine prenatal care.

By following these steps, many women navigate gallstone episodes without jeopardizing their pregnancy.

Related concepts to explore

Understanding gallstones in pregnancy opens doors to several adjacent topics that often appear in women's health literature:

• Pregnancy‑induced cholestasis - a liver disorder that can coexist with gallstones.
• Bariatric surgery timing - how prior weight‑loss procedures affect gallstone risk in future pregnancies.
• Fetal monitoring during maternal surgery - guidelines for intra‑operative ultrasound and cardiotocography.
• Post‑partum gallstone management - when to consider definitive surgery after delivery.

These topics provide a broader view of how the biliary system interacts with reproductive health.

Bottom line

If you’re pregnant and suspect gallstones, you’re not alone. The combination of hormonal changes and slowed gallbladder emptying creates a perfect storm, but modern medicine offers safe paths-ranging from low‑risk medication to minimally invasive endoscopy and, when necessary, laparoscopic removal. Talk early with your care team, keep an eye on symptoms, and follow a diet that eases bile flow. With the right plan, most women see relief while keeping their babies safe.