Can Pregnancy Worsen Gallstones and When Is Surgery Needed?

Pregnancy can indeed make gallstone disease (cholelithiasis) worse or trigger new symptoms. The hormonal shifts of pregnancy naturally slow down how your gallbladder empties, which can cause new stones to form or existing ones to cause problems ^[1][2]. Receiving a new diagnosis and discussing surgery during pregnancy can be frightening, but your care team is trained to balance maternal and fetal risks. If your condition becomes severe—such as an infection or a blocked duct—medically necessary gallbladder surgery is generally feasible and often recommended over waiting, as delaying essential treatment can be riskier for you and your baby ^[3][4].

How Pregnancy Changes Your Gallbladder

During pregnancy, your body produces high levels of estrogen and progesterone. These hormones relax your muscles to accommodate your growing baby, but they also relax the muscle wall of your gallbladder ^[1]. This relaxation prevents the gallbladder from contracting and emptying bile efficiently, a condition known as gallbladder stasis ^[5].

Because the bile sits in the gallbladder longer, cholesterol can become highly concentrated, clumping together to form biliary sludge (a thick mixture of bile and particles) or new gallstones ^[2][5]. As a result, many women who have never had gallbladder issues experience their first gallstone attack while pregnant, and those with a history of gallstones may see their symptoms worsen ^[1][2].

Recognizing Symptoms and Warning Signs

It is easy to mistake a mild gallstone attack for normal pregnancy discomfort, as nausea and vomiting are common in both ^[6]. However, biliary pain—often called biliary colic—typically causes a steady, intense aching in the upper right side of your abdomen or the center of your stomach that commonly follows a meal and lasts for several hours ^[7].

You should never assume severe right-sided abdominal pain is just standard pregnancy heartburn. These symptoms overlap with dangerous pregnancy-specific liver emergencies, such as pre-eclampsia (high blood pressure and organ damage in pregnancy), HELLP syndrome (a severe form of pre-eclampsia affecting the liver and blood), or acute fatty liver of pregnancy ^[8].

When to Seek Immediate Care:
Go to the emergency department or contact your maternity triage immediately if you experience:

• Persistent, severe right-upper-abdominal pain, fever, or yellowing of your skin or eyes (jaundice).
• Inability to keep fluids down, fainting, or confusion.
• Pregnancy-specific warning signs: severe headache, visual changes, sudden swelling, vaginal bleeding, regular contractions, or decreased fetal movement.

Do not try to manage the pain on your own with leftover prescriptions or NSAIDs (like ibuprofen), which have strict pregnancy restrictions, without consulting your obstetric care team first.

Safe Imaging Tests for Pregnant Patients

If your doctor suspects a gallstone problem, they will evaluate your vital signs, run blood tests (like liver enzymes), and order imaging.

• Ultrasound: A transabdominal ultrasound is the safest and most common first test because it uses sound waves instead of radiation ^[9].
• MRI and MRCP: If the ultrasound does not provide a clear picture, an MRI or an MRCP (Magnetic Resonance Cholangiopancreatography) is a preferred second option. These provide detailed images without ionizing radiation ^[10]. In pregnancy, MRI is typically performed without gadolinium contrast unless the expected benefit clearly outweighs the fetal risk.
• Endoscopic Ultrasound (EUS): This is a specialized, procedure-based test that uses a scope passed down your throat to look closely at the bile ducts ^[11]. It usually requires sedation and is selected by your care team when appropriate ^[12].
• CT and HIDA Scans: While these involve small amounts of radiation, they should not be withheld if clinically indicated. Your team will weigh the diagnostic benefit against the radiation dose; they are used when the result is necessary and likely to change your medical management ^[13][14].

Observation vs. Treatment Interventions

The decision between managing your symptoms medically or proceeding with an intervention depends on the severity of your condition and your gestational age.

When Observation Might Be Used

If you have uncomplicated biliary colic (mild, infrequent attacks without infection or blockage), your care team might suggest a trial of non-surgical management. This involves staying hydrated and avoiding dietary triggers. However, dietary measures do not remove the stones, and recurrence is common. In observational studies of pregnant women managed nonoperatively for uncomplicated symptomatic gallstones, some report recurrence rates of over 70% before delivery, frequently requiring repeat hospital care ^[15][1]. The decision to observe is individualized, especially late in the third trimester ^[16].

When Intervention is Recommended

Surgical guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) generally conditionally favor intervention over nonoperative management for pregnant patients with acute or complicated disease ^[16]. Interventions may involve:

• Gallbladder Removal (Cholecystectomy): Laparoscopic surgery to remove the gallbladder is often recommended if you develop acute cholecystitis (a persistent infection/inflammation of the gallbladder) or intractable pain that prevents you from eating ^[16][17].
• ERCP for a Blocked Duct: The common bile duct is the tube that carries bile from the gallbladder to the intestine. If a stone gets stuck there (choledocholithiasis), you may need a specialized endoscopic procedure called ERCP to extract the stone and clear the blockage, which is sometimes followed by gallbladder removal ^[16][18].
• Gallstone Pancreatitis: Inflammation of the pancreas caused by a blocked duct requires hospital stabilization and often surgical intervention ^[18][19].

Surgery Safety and Considerations by Trimester

While no procedure is risk-free—surgery carries risks like infection, bleeding, bile-duct injury, preterm contractions, or conversion to open surgery—laparoscopic gallbladder removal is generally feasible in any trimester when medically indicated ^[20][21].

Your care will involve multidisciplinary planning. Fetal monitoring before, during, or after a procedure is tailored to your baby’s gestational age and viability ^[22][23]. An obstetric clinician is typically consulted or available for guidance, though they may not be continuously present in the operating room. Your surgical team will also use pregnancy-specific precautions, such as left-sided tilt to improve blood flow and modified air pressure ^[24][25].

• First and Second Trimesters: Medically necessary surgery is frequently performed during this time with complication rates comparable to non-pregnant patients ^[26][27].
• Third Trimester: If you require surgery in your third trimester, your team will carefully discuss the timing. Some data suggests a slightly higher risk of preterm delivery or maternal complications if surgery is done late in pregnancy ^[26][28]. For uncomplicated biliary colic, your doctors might suggest managing symptoms until you deliver ^[16]. However, if you have a severe infection, blockage, or pancreatitis, necessary emergency surgery should not be withheld ^[29].