Recently, I had an HIDA scan and found out that my gallbladder is only releasing at 18 percent. Shortly after that, I found out I was pregnant. I want to know the risk that my gallbladder problems may pose to my baby. Can I wait to have gallbladder surgery until after the baby is born?

Jody K.

The gallbladder is a sac-like organ that stores bile and releases it during a meal to aid digestion. Under certain conditions, stones can form within the bile, a gradual process that may take months to years. In most patients, gallstones do not cause any problems. However, in some they may lead to biliary colic, a condition marked by nausea, vomiting and severe upper abdominal or right-sided abdominal pain, sometimes radiating to the back.

Gallstones are easily detected with ultrasound imaging. In some patients with typical symptoms of biliary colic, no stones are found. In some of these patients, such as yourself, further tests reveal poor gallbladder function. One of these tests is a HIDA scan with CCK stimulation. If a HIDA scan is positive, it indicates an obstruction, usually because of a stone. However, if the test is normal, then the CCK stimulation part is done. CCK is a hormone normally released by the body in response to a meal. It causes the gallbladder to contract and release its contents. When CCK is intravenously injected as part of the HIDA scan, the amount of radioactive marker in the gallbladder both before and after the injection is measured. The difference between these amounts is known as the gallbladder ejection fraction. A normal reading is about 40-75 percent. In some patients with biliary colic who are not found to have gallstones, a low gallbladder ejection fraction may indicate that gallbladder dysfunction is to blame for their pain. Many of these patients have improvement in their symptoms after their gallbladder is removed.

Pregnancy can cause gallbladder problems to develop or aggravate existing problems. The high levels of hormones (estrogens) in pregnancy cause the bile to be much thicker, thus increasing the tendency of gallstones to form. In addition, other hormones (progesterone) inhibit the gallbladder's normal ability to contract, further increasing the likelihood of stone formation. Any recommendations regarding the need for gallbladder surgery during pregnancy depend on the severity of symptoms.

In most women with biliary colic during pregnancy, the operation can be delayed until after childbirth. However, there are exceptions in which complications develop as a result of the gallbladder disease and more urgent surgery is needed. Although gallbladder disease does not directly affect the fetus, a complication certainly increases the risk for preterm labor. You should discuss your symptoms and concerns with your obstetrician. Also, a referral to a gastroenterologist or surgeon may be helpful.