Complicated gallstone disease (CGD) is a leading cause of surgery in pregnancy. Studies on the management and outcomes of CGD in pregnancy are limited by small sample size. We evaluated the association between CGD, surgical interventions, and birth outcomes in a large population-based dataset.METHODS:
Pregnant patients with gallstones were identified in the California Office of Statewide Health Planning and Development 2007–2014 discharge dataset. CGD (acute cholecystitis, cholangitis, gallstone pancreatitis) was compared with uncomplicated gallstone disease (UGD). Adverse (miscarriage, spontaneous abortion, stillborn delivery) or normal (live birth) birth outcomes were identified, as were surgical interventions (cholecystectomy, cholecystotomy, endoscopic retrograde cholangiopancreatography). Preterm delivery, among live births, was a secondary outcome.RESULTS:
We identified 5,116 eligible pregnancies: 10.6% CGD and 89.4% UGD. CGD patients had longer hospital stays (5.6 days versus 3.2 days), a higher incidence of surgical interventions (83.9% versus 6.7%), and an increased incidence of adverse birth outcomes (16.8% versus 2.6%; OR 3.23, 95% CI 2.13–4.92). CGD patients undergoing surgery had a markedly higher incidence of adverse birth outcomes compared with non-operative management (44.3% versus 7.4%; OR 5.42, 95% CI 3.24–9.08). Among live births, CGD was more frequently associated with preterm delivery when compared with UGD (26.2% versus 11.5%; OR 1.87, 95% CI 1.40–2.51).CONCLUSION:
There is an increased risk of adverse birth outcomes and preterm delivery in women with CGD. Surgical intervention is also associated with higher risk of adverse outcomes. These findings may assist clinicians in managing and counseling patients and providing informed consent.