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Carbohydrate Intake as a Risk Factor for Biliary Sludge and Stones During Pregnancy

Wong, Alan C. MD, MPH; Ko, Cynthia W. MD, MS

Journal of Clinical Gastroenterology: September 2013 - Volume 47 - Issue 8 - p 700–705
doi: 10.1097/MCG.0b013e318286fdb0

Background: High carbohydrate intake has been linked to insulin resistance, obesity, and abnormal serum lipid profiles—conditions which favor gallstone formation.

Goals: The aim of this study was to evaluate the effect of dietary carbohydrate intake on incident gallbladder disease, defined as biliary sludge and stones, during pregnancy.

Study: We prospectively studied 3070 pregnant women who underwent serial gallbladder ultrasound during pregnancy and at 4 to 6 weeks postpartum. All women had at least 2 study ultrasounds for comparison. A semiquantitative food frequency questionnaire was completed by subjects in the early third trimester. Multivariate logistic regression was performed to assess the risk of incident gallbladder disease across quartiles total and individual carbohydrate and individual carbohydrates (starch, sucrose, galactose, fructose, and lactose) intake.

Results: The cumulative incidence of gallbladder disease was 10.2% by 4 to 6 weeks postpartum. The risk of incident gallbladder disease during pregnancy was significantly higher among women in the highest quartile of total carbohydrate intake versus those in the lowest quartile (odds ratio 2.09, 95% confidence interval 1.02-4.27). High intake of fructose was associated with increased risk even after additional adjustment for total carbohydrate intake (odds ratio 2.18, 95% confidence interval 1.23-3.86, comparing highest with lowest quartile). No association was found between the intake of starch, sucrose, lactose, or galactose and the risk of incident gallbladder disease.

Conclusions: High consumption of total carbohydrate and fructose may increase the risk of developing gallbladder disease during pregnancy. Dietary modification during pregnancy might reduce gallstone incidence during this time period.

Supplemental Digital Content is available in the text.

Department of Medicine, University of Washington, Seattle, WA

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This work was funded in full by the National Institutes of Health, grant DK046890.

The authors declare that they have nothing to disclose.

Reprints: Cynthia W. Ko, MD, MS, University of Washington, Division of Gastroenterology, Box 356424, Seattle, WA 98195 (e-mail:

Received July 5, 2012

Accepted January 9, 2013

© 2013 by Lippincott Williams & Wilkins