Gallbladder Motility Change in Late Pregnancy and after Delivery

Abstract

ObjectivesThe incidence of gallstone disease has increased recently in Korea and there seems to be an increased prevalence of gallstones when in association with pregnancy. Although the pathogenesis is incompletely defined, an altered motility of the gallbladder may contribute to the increased risk of gallstones during pregnancy.MethodsWe measured gallbladder volume using real-time ultrasonography to find out the mechanism for the changes of gallbladder motility during late pregnancy. Eighteen pregnant women took the gallbladder ultrasonography during their last trimester of pregnancy and after delivery: gallbladder volume and ejection fraction were calculated in each patient.ResultsFasting gallbladder volumes increased significantly in the last trimester of pregnancy (25.28± 14.26ml) compared with postpartum (17.44±5.82ml) (p<0.05). Gallbladder volumes measured after fatty meals showed more increment in pregnant women (10.13±7.19ml) than in those after delivery (4.34±3.36ml) (p<0.005). A significantly reduced gallbladder ejection fraction was found in the pregnant group (60.56± 18.80%) compared with those after delivery (77.48± 13.37%) (p<0.005).ConclusionGallbladder motility in late pregnancy shows significant impairment compared with that in postpartum. Thus, we suggest that gallbladder hypomotility may occur during late pregnancy, and this impairment of gallbladder motility may play an important role in gallstone formation.

Risk factors associated with gallstone and biliary sludge formation during pregnancy

“…In Kapicioglu et al .’s study, the measurements were performed immediately after delivery and they found no difference in GBV and GBEF between latter stages of pregnancy and the early postpartum period 14 . In other studies, the measurements were performed as early as 3 weeks after delivery and different results were obtained 20,21 . It can be suggested that conflicting results of these studies may be due to delayed measurements.…”

“…4,5,19 GB motility change in late pregnancy and after delivery was compared in a few studies. 14,20,21 In Kapicioglu et al's study, the measurements were performed immediately after delivery and they found no difference in GBV and GBEF between latter stages of pregnancy and the early postpartum period. 14 In other studies, the measurements were performed as early as 3 weeks after delivery and different results were obtained.…”

“…However, its application is difficult and can be misleading in determining GBEF because of dislocation or configuration of GB during the latter stages of pregnancy 4,5 , 19 . GB motility change in late pregnancy and after delivery was compared in a few studies 14,20 , 21 . In Kapicioglu et al .’s study, the measurements were performed immediately after delivery and they found no difference in GBV and GBEF between latter stages of pregnancy and the early postpartum period 14 .…”

Biliary and Pancreatic Disease in Pregnancy

“…13 The smooth muscle relaxatory effect of progesterone is through inhibition of intracellular calcium mobilisation. 7,[18][19][20] There is a corresponding decrease in the gallbladder ejection fraction in late pregnancy. 17 The result is that there is an increase in both the fasting and residual volumes of the gallbladder over the second and third trimesters.…”

“…7,[18][19][20] There is a corresponding decrease in the gallbladder ejection fraction in late pregnancy. 19,22,23 It is believed that this combination of hypomotility and the alteration in relative cholesterol composition of bile predisposes pregnant women to lithogenesis. 21 These changes resolve soon after delivery.…”