Gallstones in Pregnancy: Why They Happen, What Is Safe, and When Surgery Cannot Wait

Gallstones are more likely to form in pregnancy because of the extra oestrogen the body makes, and while many cause nothing at all, an attack in pregnancy needs the same prompt assessment as in anyone else; if surgery is needed, keyhole gallbladder removal is considered safe in any trimester, with the second the preferred window. The fear most women bring to this, that an operation will harm the baby, is understandable, and the current evidence points the other way for the most serious gallstone complication¹.

I was not pregnant when my gallbladder misbehaved, but I have read more messages on this subject than almost any other since the site began, usually from women who have been told “it can probably wait until after the baby” and do not know whether to feel relieved or worried. Sometimes it can wait. Sometimes it really should not. This page sets out where the line falls, and every figure has been checked by a consultant general surgeon.

Why pregnancy makes gallstones more likely

Extra oestrogen during pregnancy can make bile more likely to form stones, so pregnant women are one of the groups at higher risk.

The US National Institute of Diabetes and Digestive and Kidney Diseases lists women among those more likely to develop gallstones, and notes that women with extra oestrogen in their body, from pregnancy, hormone replacement therapy or birth control pills, may be more likely to produce them². Gallstones are found in around 10 to 15% of adults overall, and roughly 80% of them never cause symptoms³, so many pregnant women with stones will never know about them.

Some find out because a scan done for another reason picks them up; others because of a first attack.

What an attack in pregnancy feels like, and why it needs checking

A gallbladder attack in pregnancy feels the same as at any other time, a severe gripping pain under the right ribs or in the upper middle of the tummy, but upper abdominal pain in pregnancy always needs assessment because it has other causes too.

The classic attack, biliary colic, is a severe pain that builds, often after a meal, can last from minutes to a few hours, and may come with nausea and vomiting⁴. In pregnancy, though, pain in the upper right of the tummy can also come from conditions specific to pregnancy, some of them serious, and a growing womb can change where things hurt. That is why the right move is a same day call to your maternity unit or GP rather than assuming it is “just the gallbladder”.

The red flags are the same as for anyone with gallstones: pain that does not settle, a high temperature or shivering, yellowing of the skin or the whites of the eyes, or severe pain spreading through to the back with vomiting. The NHS advises calling 999 or going to A&E for these⁴. They point toward acute cholecystitis, a stone in the bile duct, or gallstone pancreatitis, and in pregnancy they matter for two people.

Is gallbladder surgery safe during pregnancy?

Yes. Current guidance considers keyhole removal safe in pregnancy, describing it as the standard approach in any trimester and ideally done in the second.

The American Gastroenterological Association’s 2024 practice update on pregnancy related digestive and liver disease states plainly that cholecystectomy is safe during pregnancy, and that a laparoscopic approach is the standard of care regardless of trimester, but ideally in the second¹. The usual explanation for preferring the second trimester is that it falls after the early weeks of the baby’s development and before the womb is large enough to make keyhole access harder.

The Society of American Gastrointestinal and Endoscopic Surgeons reached a similar view in its 2024 guideline, built on a systematic review and meta-analysis. It made a conditional recommendation for laparoscopic cholecystectomy over non-surgical treatment for biliary disease in pregnancy, and for acute cholecystitis specifically⁵. Conditional is the honest word: these are recommendations drawn from mostly observational data, and the details of any one pregnancy can change them.

The operation itself is the same keyhole gallbladder surgery done for anyone else, with the surgical and anaesthetic teams working with obstetric colleagues on positioning, monitoring and the care of the baby. Your team will explain what that looks like where you are.

Operate now or wait until after the birth?

For acute cholecystitis, the evidence now favours operating; for milder gallbladder trouble late in pregnancy, either approach is reasonable, which is where waiting until after the birth often fits.

The strongest data come from a 2024 study in JAMA Surgery that looked at 5,759 pregnant people with acute cholecystitis and matched them with 23,036 pregnant people without it. Acute cholecystitis, however it was treated, was associated with higher odds of pregnancy loss or preterm delivery (odds ratio 1.69, 95% CI 1.54 to 1.85). Among those followed for a year, having surgery was associated with lower odds of those outcomes than non-surgical care (odds ratio 0.75, 95% CI 0.63 to 0.87), and the association held across all three trimesters⁶. Only about a third of those with cholecystitis had their gallbladder removed during the pregnancy, and far fewer in the third trimester than the first two, which shows how often the instinct to wait still wins. This was an observational study using insurance records, so it shows an association rather than proof, but it fits the guideline direction.

For gallbladder problems other than acute cholecystitis in the third trimester, the SAGES panel suggested, on expert opinion, that either surgery or non-surgical management is reasonable⁵. That is the situation in which “it can wait until after the baby” is a sound plan: uncomplicated attacks late in pregnancy, managed with pain relief your team agrees is safe, and a planned operation afterwards. Outside pregnancy, NICE recommends keyhole removal for people with symptomatic gallstones⁷, and that advice picks up again once the baby has arrived.

If you do wait, the advice in waiting for gallbladder surgery applies, with one addition: anything that changes, a longer attack, a fever, yellowing, goes to your maternity team and the surgical team the same day.

Stones in the bile duct during pregnancy

A stone blocking the main bile duct in pregnancy is usually treated with ERCP, an endoscopic procedure, ideally in the second trimester.

The AGA update says ERCP may be performed in pregnancy for urgent problems such as a stone in the bile duct, an infected bile duct (cholangitis) and some cases of gallstone pancreatitis, ideally in the second trimester, with a multidisciplinary team deciding when delay would be harmful¹. SAGES suggests ERCP rather than surgical exploration of the bile duct for a symptomatic duct stone in pregnancy⁵.

Eating, and what to ask

There is no diet that dissolves gallstones in pregnancy, but smaller, lower fat meals may mean fewer attacks for some women; nutrition for the baby comes first, so check any changes with your midwife.

A large fatty meal makes the gallbladder squeeze hardest, which is why some people find smaller meals help, but cutting fat out entirely or eating much less is not the answer in pregnancy, when your energy needs are higher. Rapid weight loss raises the chance of forming stones in anyone³. Ask your midwife or a dietitian before making big changes.

When you see the team, these questions tend to be the useful ones: Is this pain definitely from the gallbladder, or are you checking for anything else? Is this an uncomplicated attack or a complication? If surgery is suggested, why now rather than after the birth, and if waiting is suggested, what would change that? Who do I call, day or night, if the pain comes back differently? The answers belong to the surgeon and obstetric team who can examine you, not to a website, but going in with the questions makes it far easier to hear the answers.