CHOLELITHIASIS DURING PREGNANCY AND LACTATION

Objective. To assess the incidence of formation of gallstones during p regnancy and lactation, the time when gallstones first appear, and any changes in predisposing factors. Design: Prospective study. Setting: District hospital, Greece. Subjects: 669 pregnant women seen between 1 988 and 1991. Main outcome measures: Body mass index (kg/m(2)); real t ime ultrasonography; and measurements of serum concentrations of bilir ubin, total cholesterol, low density lipoprotein cholesterol, and trig lycerides, and of activities of alanine aminotransferase, aspartate am inotransferase, alkaline phosphatase, and amylase. All measurements we re made at the beginning of pregnancy; at the third, sixth and ninth m onths; and 7 days and 6 months after delivery. Results: 6 women (1%) m ean age 26 years, had pre-existent gallstones and 14 further women (2% ) mean age 27 years, developed gallstones; 13 were discovered during p regnancy (8 during the second trimester, and 5 during the third) and o ne during lactation. Women who had 3 or more pregnancies (6/110, 5%) w ere significantly more likely to develop gallstones than those who had not been pregnant before (3/304, 1%, p = 0.01). Gallbladder volume mo re than doubled during pregnancy from a mean (SD) of 12 (4) to 26 (4) mi. Total cholesterol, low density lipoprotein cholesterol and triglyc eride concentrations, and alkaline phosphatase activity increased grad ually, and reverted to the value found at the beginning of pregnancy i mmediately after delivery. Conclusions: The risk of developing gallsto nes increased with the number of pregnancies, and most of the stones d eveloped during the second or third trimester.