Acute Pancreatitis and Pregnancy
Timothy Gardner, MD
Acute pancreatitis is defined as the sudden inflammation of the pancreas manifested clinically by abdominal pain, nausea and dehydration that is usually self-limiting but occasionally can progress to severe disease and even death. There are many causes of acute pancreatitis – the two most common being alcohol use and gallbladder/bile duct disease. In this review, we will discuss the specific case of acute pancreatitis in pregnancy.
Reasons for Acute Pancreatitis and Pregnancy
While acute pancreatitis is responsible for almost 1 out of every 200 hospital admissions in the United States annually, fortunately the rate of acute pancreatitis in pregnancy is rare. It is estimated that acute pancreatitis occurs in about 1 out of every 10,000 pregnancies – however, this rate varies depending on the region and type of hospital. Most cases of acute pancreatitis in pregnancy are caused by gallstone disease. It is thought with the weight and hormonal changes induced by pregnancy, gallstones are more likely to form and thus travel down the common bile duct to obstruct the pancreas duct outflow. Another proposed mechanism for acute pancreatitis in pregnancy is high fat levels in the blood called triglycerides. Again, the hormonal changes of pregnancy can predispose certain women to developing this condition. When the triglyceride levels become too high, oxygen cannot adequately travel to the pancreas via the bloodstream, and pancreatitis can ensue. Of course, all of the other reasons for developing acute pancreatitis – alcohol use, reaction to certain medications, trauma to the pancreatic duct – can also lead to acute pancreatitis in pregnancy
Treatment of Acute Pancreatitis in Pregnancy
The treatment of acute pancreatitis in pregnancy is similar to that of non-pregnant patients with some exceptions. Resting the digestive tract by not eating, pain control and aggressive fluids given through an IV line are essential. Typically, if the reason is gallstone pancreatitis, removal of the gallbladder is deferred until after pregnancy. Often, a stent placed into the bile duct can be placed to temporize the situation until operative resection is needed. However, if waiting until the end of pregnancy is not possible, surgical resection can generally be performed safely. If the cause of acute pancreatitis is due to triglycerides, certain medications and dietary modifications can be used to help prevent recurrent attacks. However, if the attack occurs late in the third trimester, delivery is usually advocated, as this will cause an immediate decrease in the triglyceride level. Other causes of acute pancreatitis, such as traumatic ductal injury, need to be carefully assessed on an individual basis.
Outcomes of Acute Pancreatitis in Pregnancy
Fortunately, the rate of maternal mortality is less than 1% for acute pancreatitis in pregnancy. The rate of pre-term delivery, however, is about 20%. Also in patients with non gallstone pancreatitis, the rate of pre-term delivery appears to be somewhat higher. It is very important, therefore that pregnant patients present as soon as possible to the emergency room for evaluation should they develop any abnormal abdominal pain symptoms.
While a rare event, acute pancreatitis does occur in pregnancy. Fortunately, if treated early, generally pre-term labor can be avoided and the incidence of recurrent attacks minimized.
Timothy Gardner, MD is Director of Pancreatic Disorders at Dartmouth-Hitchcock Medical Center in Hanover, NH. He graduated from the University of Connecticut Medical School. He did his residency at Dartmouth-Hitchcock and his fellowship at the Mayo Clinic in Rochester, MN. He is a regular contributor for the National Pancreas Foundation website and newsletters.