How is a gallbladder attack or gallstone problem affected by pregnancy? I have a friend who has thrown up for eight months, and the doctors told her it was probably her gallbladder. They said gallbladder problems often occur during pregnancy. Why?

Jamie

Gallstones are very common in our society. It's estimated that up to 30 percent of women over age 50 have gallstones. Stones cause problems by temporarily blocking the cystic duct leading out of the gallbladder, resulting in abdominal pain, nausea, vomiting and fever. These episodes, called biliary colic, often lead doctors to recommend removal of the gallbladder.

During pregnancy, a couple of factors increase a woman's propensity to form gallstones. First, the hormonal milieu, with high levels of estrogen, leads to higher levels of cholesterol in bile. Bile is made by the liver and stored in the gallbladder between meals. The higher concentration of cholesterol leads to formation of microcrystals, which slowly grow to form larger stones in the gallbladder. Secondly, the gallbladder enlarges during pregnancy, becoming more flaccid and losing its ability to empty after meals. Again, hormonal changes (probably increased progesterone levels) are responsible for this. This decreased gallbladder activity leads to stagnation of bile and greater propensity to form stones in the gallbladder. Overall, about 30 percent of pregnant women develop gallbladder sludge -- thick bile with small crystals, which can cause pain (biliary colic). Two percent of pregnant women develop actual gallstones, which are even more likely to cause pain. In most cases, the gallbladder can be removed after the pregnancy to prevent future episodes.

When a pregnant woman experiences nausea and vomiting, gallbladder disease must be considered. However, other causes must be entertained as well. Keep in mind that some nausea and vomiting occurs in over half of all pregnancies. But obviously, a pregnant woman who vomits for eight months is not the typical case.

An entity known as hyperemesis gravidarum (HG) occurs in about one in 300 pregnancies. In this condition, nausea and vomiting are severe and intractable, requiring hospitalization and IV fluids to prevent or treat dehydration. HG usually begins in the first trimester, and usually disappears by the end of the second trimester. It occurs most commonly in older women during their first pregnancy and is also associated with obesity. The cause is unknown.

Gastroparesis is also a relatively common cause of nausea and vomiting during pregnancy. In this condition, the stomach fails to contract and empty properly after a meal. Again, high levels of hormones may be implicated. Other less common conditions that can lead to nausea and vomiting in pregnancy include hyperthyroidism (an overactive thyroid gland), pancreatitis (inflammation in the pancreas) and hepatitis (inflammation of the liver).

I would expect that in your friend's case, given that her symptoms have been present for almost the entire pregnancy, a proper workup was done to find the cause. If not, she should discuss this with her doctor. Often no cause is found, and these cases are usually attributed to HG. The key is to rule out other causes, such as gallstones, for which a therapy is available.