A study of cholelithiasis during pregnancy and its relationship with age, parity, menarche, breast-feeding, dysmenorrhea, oral contraception and a maternal history of cholelithiasis

Abstract

We prospectively studied 512 consecutive women attending the antenatal clinic of the Rotunda Hospital of Dublin, Ireland, to assess the prevalence of gallstones among them and to describe the characteristics of those women found to be gallstone-positive (group 1), compared with the negative-control population (group 2). Real-time ultrasound scanning of the pelvic area was extended to the upper part of the abdomen. Cholelithiasis was detected in 23 patients. No substantial difference was found in parity of group 1 as compared with group 2. Also, early pregnancies, age at menarche and oral contraception did not have any significant difference between the two groups. However, we recorded a significantly higher prevalence of cholelithiasis in older women and in patients with dysmenorrhea. A positive trend was found in patients who had a history of previous breast-feeding and in women with a positive maternal history of symptomatic gallstones.

PIP: In 1990, physicians used real time ultrasound scanning to examine the pelvic area and the upper part of the abdomen in a prospective study of 512 healthy, pregnant women (around 15.5 weeks gestation) attending the prenatal clinic at the Rotunda Hospital in Dublin, Ireland to determine the prevalence of gallstones. Most women also completed a questionnaire. Just 23 women (4.5%) had gallstones. 7 (30.4%) had earlier experienced a cholectectomy and another 2 (8.7%) had already been diagnosed with cholelithiasis. Thus, 14 (60.9%) pregnant women were unaware of the presence of gallstones. There was a higher proportion of women older than 30 years old with cholelithiasis than free of cholelithiasis (60.9% vs. 29.4%; p .01). Women with gallstones were more likely to experience irregular, painful menstrual periods than the controls (30.4% vs. 15%; p .05). Even though parity was not associated with cholelithiasis, the researchers observed a higher parity among symptomatic mothers than among asymptomatic mothers (2.8 vs. 1.1). This indicated that pregnancy may increase the prospect of symptoms in women who where unaware of the gallstones. Menarche, breast feeding, oral contraceptive use, and history of cholelithiasis were also not associated with gallstones. Yet, there was a positive trend of cholelithiasis in women who breast fed and in those who had a family history of gallstones. Further research is needed to investigate these 2 positive trends. These results indicated that real-time ultrasound scanning detected gallstones in 60.9% of pregnant women who did not know they had them. Thus, health providers should use this screening tool to also scan the upper part of the abdomen when scanning the pregnant uterus to detect the presence of asymptomatic cholelithiasis.