Gallstone Disease in Pregnancy

Clinical Presentations

The American College of Gastroenterology recommends that symptomatic biliary colic is the most common presentation of gallstones in pregnancy, though patients may also develop acute cholecystitis, pancreatitis, or cholangitis 1
Patients with gallstones in pregnancy often experience right upper quadrant or epigastric pain that is typically episodic and colicky in nature 1
The American Gastroenterological Association notes that pain may radiate to the back or right shoulder, and is often triggered by high-fat meals 2
The Society of American Gastrointestinal and Endoscopic Surgeons states that persistent right upper quadrant pain, fever, and signs of systemic inflammation are characteristic of acute cholecystitis 2
Severe epigastric pain radiating to the back, nausea, and vomiting are symptoms of gallstone pancreatitis, according to the American College of Gastroenterology 1
Right upper quadrant pain with fever and jaundice, also known as Charcot's triad, is a symptom of cholangitis, as noted by the American Association for the Study of Liver Diseases 1

The American Institute of Ultrasound in Medicine recommends that ultrasound is the diagnostic imaging modality of choice for detecting gallstones during pregnancy, due to its high sensitivity and specificity without radiation exposure 1, 2, 3
Elevated serum ALT and bile acids may accompany symptoms of gallstone disease, according to the American Association for the Study of Liver Diseases 1
Normal bilirubin, prothrombin time, and gamma-glutamyltransferase should be expected in uncomplicated biliary colic, as stated by the American College of Gastroenterology 4

The American College of Obstetricians and Gynecologists notes that gallstone-related disease complicates 0.5% to 0.8% of pregnancies, and gallstones may occur in up to 10% of pregnancies overall 1, 3
High prepregnancy BMI and elevated serum leptin levels are the strongest risk factors for gallstone disease in pregnancy, according to the American Gastroenterological Association 1
Hormonal changes during pregnancy cause decreased gallbladder motility and lithogenic bile, as stated by the Society of American Gastrointestinal and Endoscopic Surgeons 1, 5

The American College of Gastroenterology recommends that 60% of pregnant patients with gallstone disease treated conservatively develop recurrent biliary symptoms, leading to multiple hospitalizations 2
Patients managed conservatively are more likely to require cesarean delivery, as noted by the American College of Obstetricians and Gynecologists 2

The American Association for the Study of Liver Diseases states that normal physiologic changes in pregnancy can mimic chronic liver disease, including spider angiomas and palmar erythema 4, 6
Alkaline phosphatase increases normally in second and third trimesters due to placental origin, as noted by the American College of Gastroenterology 4
Leukocytosis occurs physiologically in pregnancy, making it unreliable for diagnosing acute cholecystitis, according to the American Gastroenterological Association 2