What is gallstasis during pregnancy?
Gallbladder is formed in the liver and is excreted via the bile ducts of the liver for storage in the gallbladder, or directly into the small intestine. In the gut, the bile is important for the breakdown of fat. At gallstones, the liver swells up and the bile ducts become partially pinched. Thus, a certain amount of bile is squeezed out into the blood, causing an increased amount of bile dyes and bile acids in the blood. Increased amounts of bile substances in the blood are the direct cause of the painful itching typical of this disease.
What’s the matter?
Gallstas occur only during pregnancy. It is unknown what triggers the condition, but experts believe there may be an increased sensitivity to the high hormone levels during pregnancy. Probably it is a reaction to high levels of estrogen.
The figures for the prevalence of the disease are uncertain, but it is stated that 1-3% of pregnant women in Scandinavia are affected, which means about 10,000 to 30,000 cases annually in Sweden. The disease is more common in Asian countries than in Europe.
The typical course is that the pregnant woman suffers from abnormal and intense itching. Itching usually occurs throughout the body, usually most intensively in the palms and soles of the feet. The itching is usually worse at night. Most suffer from the pain during the latter part of the pregnancy, usually during the second or third trimester. There is no rash with the itching. At about 10% there is a mild jaundice.
In the medical examination, gallstones are separated from other diseases that cause itching during pregnancy by means of blood tests. The level of bile acids in the blood is clearly elevated, although some other liver tests may cause rashes.
Is the disease dangerous?
This condition causes a slight increase in the risk of sudden fetal death. It is impossible to assess the risk in individual cases, but overall the risk of sudden fetal death is estimated to be 0.5–3.5%, in other words, it will perform well in 96.5–99.5% of cases. Premature labor occurs to a somewhat greater extent. Otherwise, the illness does not cause harm or error to the child.
For the mother, the disease is harmless. The itching disappears and the blood samples are normalized a few days after birth.
Treatment is done with a medicine that lowers the level of bile acids in the blood (ursodeoxycholic acid). This has been shown to lead to improvement of the itching and improvement of the blood samples, but it has not been proven with any certainty that the treatment leads to a reduced risk of fetal death. Research has shown that the drug is safe for both the mother and the child.
Mothers with gallstones are offered extra monitoring and fetal monitoring. In cases of very high bile acid levels, it may be necessary to expedite the delivery. This is discussed individually between the pregnant and the maternity ward.