Pregnancy and Cholelithiasis: Pathogenesis and Natural Course of Gallstones Diagnosed in Early Puerperium

Abstract

Several recent reports have indicated an increased prevalence of gallstones in association with pregnancy. If these reports are true, the early puerperium should be a favorable time to detect the disease in its initial stages and follow its natural course. Accordingly, the gallbladder was examined by ultrasound in 980 women during the immediate postpartum period and in 150 nulliparous, age-matched healthy volunteers. Gallstones were detected in 12.2% of the puerperal women and in 1.3% of the control group. In 70 patients who had stones in a functioning gallbladder, 22 (31%) had had attacks of biliary colic. The history of pain was more common in patients with stones greater than 10 mm in diameter. Forty-one women with small stones (< 10 mm) were followed clinically and ultrasonographically for between 6 and 24 (mean = 8.7) mo. All remained pain-free, and in twelve subjects (29%) the stones disappeared. Gallbladder bile was examined in 11 normal volunteers (controls) immediately after delivery and in 19 women with small stones 39 +/- 6 days postpartum. Bile was saturated with cholesterol in the controls and was unsaturated in patients with gallstones. We conclude that in our population pregnancy is a very important pathogenetic factor favoring gallstone formation. Attacks of biliary colic appear early and frequently in young Chilean women with this disease. Unexplained disappearance of small stones frequently occurs: in some cases it is likely to be the result of spontaneous dissolution because bile becomes unsaturated within a few weeks of delivery.

Apolipoprotein E genotype and the risk of gallbladder disease in pregnancy

“…[2][3][4] Pregnancy thus represents a period of accelerated formation of sludge and stones and constitutes an ideal situation to study risk factors for these entities. Sludge is viewed by most investigators as a necessary precursor to gallstones.…”

“…Biliary sludge, a potential precursor to gallstones, forms in up to 30% of women during pregnancy, and gallstones form in 2% to 4%. [2][3][4] Biliary sludge, or microlithiasis, in pregnancy consists of clusters of cholesterol crystals in bile, which cast characteristic low amplitude echoes by ultrasonography. 5 Although not all cases of sludge will necessarily evolve to become gallstones, sludge is believed to be the initial step in gallstone formation 6 and is regarded as the earliest recognizable stage of lithogenesis.…”

Problematiche internistiche in corso di gravidanza

“…È noto che il livello medio del BNP nel plasma durante la gravidanza raddoppia. 47 Tanous e coll. dimostrarono infatti che un piccolo gruppo di 66 gravide con cardiopatia sia congenita che acquisita presentavano un livello medio di BNP doppio rispetto al gruppo di controllo, costituito da 12 donne gravide sane.…”

“…46 Si è osservato come la concentrazione di un marker infiammatorio, chiamato heat shock protein (HSP) -70, sia maggiore nelle donne gravide asmatiche rispetto a quelle sane. 47 Il fumo e l'obesità sono fattori aggiuntivi in grado di incrementare la mortalità delle pazienti asmatiche. 34 Un recente studio basato sul controllo dell'asma nelle donne in gravidanza ha analizzato i sintomi ed il loro effetto sulle attività quotidiane, la qualità del sonno, il tasso di ospedalizzazione e di riacutizzazioni asmatiche.…”

“…[45][46][47][48] La dieta deve essere sempre individualizzata, prendendo in considerazione fattori come l'indice di massa corporea della paziente (BMI) e lo stato nutrizionale, per evitare una eccessiva restrizione calorica che può provocare chetonuria e outcomes negativi.…”