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Changes to the liver, gallbladder, and pancreas are mostly caused by the increase in progesterone during pregnancy, which may cause organ motility to slow down (similar to the stomach).

Most pregnant women will not have any issues due to these organ changes. However, in some cases, due to slower movement of the gallbladder, it is possible that bile salts can back up and affect one or more of these organs leading to gallstones, gall sludge, abdominal pain, or pancreatitis (rare), all of which usually reverse after delivery.

Additionally, for some women, the pancreas may have trouble with the increased amount of insulin required during pregnancy, leading to gestational diabetes.

Even though most women will not experience any major concerns related to these organ changes, it can be helpful for women to understand why pregnancy-related changes in these organs may lead to specific symptoms and conditions, what they should look out for, and when they should call their HCP.

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Although pregnancy does cause changes to the liver, gallbladder, and pancreas, most women will not experience any symptoms or concerns related to these changes.

However, in some cases, women can experience symptoms such as abdominal pain or constipation, but usually only when these changes progress into a particular condition or disease.

Gallbladder problems are the most common, but can be successfully managed and treated when women understand the signs and symptoms and call their HCP.


The liver does not physically change during pregnancy but it can get moved higher and slightly toward the woman's back. Therefore, if an HCP can physically palpate the liver through the abdomen during pregnancy, this would indicate a concern for some form of liver disease.

The gallbladder is a small organ located underneath the liver.

Pregnancy's effect on liver function tests (lab/blood work) is likely the most significant change to the liver:

Due to the increase in plasma (component of blood), liver function tests are technically “abnormal”, which, during pregnancy, is considered normal. This can make catching some liver conditions more challenging – especially those specific to pregnancy.

Liver problems can occur during pregnancy that only happen during pregnancy – such as Intrahepatic Cholestasis of Pregnancy (ICP) (extreme, intense itching) and Acute Fatty Liver of Pregnancy (abdominal pain, nausea, vomiting, fatigue).

Note: Itchy skin during pregnancy can be caused by various reasons during pregnancy; therefore, itch is not always indicative of liver concerns (read more).


The gallbladder is a small organ located underneath the liver that stores and releases bile to help digest fatty foods.

However, it's ability to release bile at regular rate is slowed down during pregnancy due to progesterone. This sluggishness can cause bile to back up/block the bile ducts and plays a large role in gallstone and glass sludge formation during pregnancy.

Progesterone has an inhibitory effect on the ability of smooth muscle to contract in certain organs (i.e. stomach, uterus, gallbladder). High levels of progesterone during pregnancy are necessary to prevent the uterus from contracting (until term); however, as a side effect, high progesterone also affects and "slows down" the stomach and gallbladder.

Additionally, later in pregnancy, it is possible the large uterus pushes toward the gallbladder which can lead to easier migration of gallstones into the common bile duct, leading to symptoms (abdominal pain).

Gallbladder disease (gallstones/sludge) is already four times more common in women than men, and pregnancy increases this risk even further. Gallbladder sludge or gallstones develop in approximately 31% and 5% of pregnant women respectively, and is a common cause of hospitalization for women up to one year after delivery (not all cases require treatment).

Gallstones are hardened deposits of bile within the gallbladder.  A stone can be as small as a grain of sand or as large as a golf ball; diagnosed through abdominal ultrasound.

Gallsludge is similar to stones, but is not completely solid; a thicker "sludge" of collected bile.

Gallsludge or stones that do not cause symptoms do not need treatment, as this condition generally resolves after delivery.  However, some women may have symptoms that increase afterward diagnosis, and removal of the gallbladder may be necessary in the postpartum period.

Some researchers have advocated for routine evaluation of the gallbladder during scheduled ultrasounds. This could help identify women with gallstones and possibly prevent further complications, especially in the postpartum period.

Pregnant women who develop gallstones are generally closely monitored. If a gallstone blocks the gallbladder or causes an infection, surgery may be necessary.

Surgery (cholecystectomy) is considered safe for pregnant women (and fetuses), is the second most common non-obstetric related procedure during pregnancy, and can be performed in any trimester (second trimester may be best).


The pancreas is a large gland behind the stomach that releases insulin to control blood sugar; it also makes enzymes to help break down food.  When the pancreas releases insulin after a meal, the insulin helps move glucose from the bloodstream into the body's cells, where the glucose is used as energy.

Pregnancy causes a state of insulin resistance in almost all women:

Hormones from the placenta block the action of the mother's insulin in her body – this is normal during pregnancy. However, this insulin resistance makes it harder for the mother's body to use insulin.

As the fetus continues to grow, the placenta produces more and more insulin-counteracting hormones; fortunately, in most women, the pancreas adjusts to this resistance by releasing additional insulin.

When a woman's pancreas does not release this additional insulin, glucose can build up in the blood, leading to gestational diabetes (and potential complications).

Note: Insulin resistance peaks around mid-pregnancy, which is why women are screened for gestational diabetes between 24 and 28 weeks of pregnancy.

Gallstones can lead to inflammation and swelling of the pancreas, known as acute pancreatitis, occurring in about 1 to 3 in 10,000 pregnancies. Inflammation occurs as the pancreas’ digestive enzymes start digesting the pancreas itself.

Although rare, gallstones can lead to the development of pancreatitis during pregnancy (called gallstone pancreatitis).
Scientific Animations. CC BY-SA 4.0

The most common symptom of pancreatitis is pain in the upper abdomen that may spread to the back which may be worse after eating. It can also include fever, chills, nausea, and vomiting.

Pancreatitis is diagnosed with lab work and various imaging studies (CT scan, ultrasound, MRI).  Pancreatitis results in hospitalization and treatment with IV fluids, pain medicine, and no food or beverages for several days, especially if severe. This allows the pancreas to heal back to normal. Afterward, a low-fat diet is followed for a period of time as determined by an HCP.


Women should report any abdominal pain or intense itching to their HCP, regardless of trimester. Nausea and vomiting, especially in the second trimester, should also be brought to the attention of an HCP.

Women should also read more information regarding glucose screening during pregnancy.


Liver, Gallbladder, and Pancreas (Johns Hopkins Medicine)

Acute Pancreatitis and Pregnancy (The National Pancreas Foundation)


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