title: Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment.
abstract: Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA.
authors.forename: Ornella
authors.initials: O
authors.lastname: de Bari
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA; Department of Biomedical Engineering, Washington University, St. Louis, USA.
authors.forename: Tony Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA.
authors.forename: Chang-Nyol
authors.initials: CN
authors.lastname: Paik
authors.affiliation: Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Portincasa
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA.
authors.forename: David Q-H
authors.initials: DQ
authors.lastname: Wang
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001384:Azetidines / Q000627:therapeutic use; D001646:Bile / Q000378:metabolism*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000378:metabolism* / Q000517:prevention & control / Q000628:therapy; D002784:Cholesterol / Q000378:metabolism*; D004967:Estrogens / Q000378:metabolism*; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism* / Q000517:prevention & control / Q000628:therapy; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D002756:Cholagogues and Choleretics; D004967:Estrogens; D014580:Ursodeoxycholic Acid; D002784:Cholesterol; D000069438:Ezetimibe