Gallstones during pregnancy

By trimester

Weeks 1–13

1st trimester

Upper-right abdominal pain with fever, jaundice, or ongoing vomiting needs prompt assessment even early in pregnancy. Ultrasound can look for gallstones without ionizing radiation, while blood tests help check for infection, liver obstruction, or pancreatic inflammation.

Weeks 14–27

2nd trimester

Recurrent biliary colic can progress to gallbladder inflammation, bile-duct obstruction, or pancreatitis. Current surgical guidance conditionally favors laparoscopic gallbladder removal over nonoperative care for acute cholecystitis during pregnancy, although the evidence is low certainty.

Weeks 28–birth

3rd trimester

Biliary colic without complications requires individualized discussion because both operative and nonoperative approaches may be considered late in pregnancy. Fever, jaundice, persistent pain, or pancreatitis signs still require urgent assessment and should not wait until after birth.

What does the evidence show for gallstones?

• A gallbladder attack commonly causes upper-right abdominal pain that can last several hours, often after a heavy meal. Persistent pain, fever or chills, vomiting, jaundice, dark urine, or light stools can signal inflammation, infection, or duct blockage and requires prompt care. 1
• Ultrasound is the best first imaging test for gallstones. Blood tests can show inflammation or infection involving the gallbladder, bile ducts, pancreas, or liver, while MRI and selected ERCP are used when a common bile-duct stone is a concern. 2
• A prospective study of 3,254 pregnant women found new biliary sludge or stones on at least one ultrasound in 5.1 percent by the second trimester, 7.9 percent by the third trimester, and 10.2 percent at 4 to 6 weeks after birth. Many findings regressed, and ultrasound findings did not necessarily mean symptoms. 3
• A 2024 SAGES guideline conditionally favored laparoscopic gallbladder removal over nonoperative care for biliary disease and acute cholecystitis during pregnancy. For third-trimester biliary colic, either approach may be considered. Most evidence was observational and rated low or very low certainty. 4
• Gallstones are the most common cause of acute pancreatitis. Severe or worsening upper-abdominal pain that may spread to the back, especially with fever, repeated vomiting, a fast heartbeat, shortness of breath, or jaundice, needs immediate medical assessment. 5

When should I call my provider about gallstones?

Seek urgent assessment for upper-right or upper-middle abdominal pain that persists, becomes severe, or occurs with fever, chills, jaundice, dark urine, pale stools, or repeated vomiting. Severe pain spreading to the back, shortness of breath, fainting, confusion, or marked illness is an emergency because gallbladder infection, bile-duct obstruction, or pancreatitis may be present. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.