The impact of gallstone intervention during pregnancy on maternal and perinatal outcomes: a nationwide population-based cohort study.

Background and aims: Gallstone disease during pregnancy can have varying consequences, from mild to severe and even life-threatening. The aim was to investigate how gallstone intervention during pregnancy impacts pregnancy, delivery and the newborn child.

Methods: Pregnant patients 18-45 years identified from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2009-2016 constituted the intervention group and were cross-linked with the Swedish National Medical Birth Register. A 1:5 matched control group of patients without gallstone intervention during pregnancy was established.

Results: In total, 1620 women were included, and of these, 274 underwent gallstone intervention during pregnancy. Some 221 women underwent cholecystectomy only, and 53 underwent ERCP only or combined with cholecystectomy. The women in the intervention group had a higher BMI at the start of pregnancy (24 vs 28, p < .001) and were more often smokers (21.7% vs. 15.7%, p = .019). Overall, labour started most often spontaneously, (intervention group 67.0% vs. control group 75.3%, p = .004), and elective caesarean section was more common in the intervention group (13.2 vs. 9.0%, p = .034). Premature birth was more common in the intervention group (19 [6.93%] vs. 5 [3.94%], p = .029), with an adjusted odds ratio of 1.8 (CI 1.1-3.3, p < .001). There were no differences in the children's birth weights or APGAR scores.

Conclusions: Caesarean section was more common, and the duration of pregnancy was shorter, including preterm births, in the group with gallstone intervention during pregnancy. However, for the newborn child, birth weight corrected for gestational age and APGAR score was not affected.