Gallstone disease in pregnancy: Mere coincidence or physiologic response?

Albeit there have been numerous reports, but it has still not been completely clarified what the exact role (if any) of pregnancy is in the development of gallstone disease, or its influence in previously existing silent disease. Controversy remains, but a direct relation seems to exist between the number of pregnancies and the appearance of gallstones or sludge, mainly in young mothers. However, in many instances there has been a regression or disappearance of sludge, or even stones after delivery. Physiologically, pregnancy also affects the bile and the gallbladder (structurally and mechanically), probably rendering this combination of effects very lithogenic. In this review, the world literature is discussed and conclusions, as much as data permit, are reached regarding epidemiology, physiology, diagnosis and management of gallstone disease during pregnancy.