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JAMA Network Insights
September 30, 2020

Management of Gallstone Disease During Pregnancy

Author Affiliations
  • 1Division of Trauma and Critical Care, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
JAMA Surg. Published online September 30, 2020. doi:10.1001/jamasurg.2020.3683

Symptomatic gallstone disease during pregnancy is common. Acute cholecystitis is the second most common nonobstetric indication for surgery during pregnancy, occurring in about 1 per 1600 pregnancies. During pregnancy, elevated estrogen increases cholesterol secretion and progesterone reduces bile acid secretion and delays gallbladder emptying, leading to the supersaturation of bile with cholesterol and predisposition to gallstone formation. In a prospective ultrasonography study of 3200 pregnant patients, new gallstones were identified in nearly 8% of women by the third trimester, and 1.2% of them developed symptomatic gallstone disease.1 Therefore, most clinicians will encounter pregnant patients with symptomatic cholelithiasis, acute cholecystitis, and gallstone pancreatitis within their practice. Unfortunately, the current literature is limited to retrospective case series and reports, and this has led to varying management strategies. In what is to our knowledge the largest population-based data linkage study, including more than 1 million pregnancies, 87.3% of women with gallstone disease were managed conservatively, without surgery.2 This is despite evidence suggesting that surgical treatment has lower complication rates than conservative management for gallstone disease in pregnancy.3 Given the limitations of the current available data, the purpose of this article is to provide best care practices for the management of gallstone disease during pregnancy.

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