Ibiebele I, et al. – This paper focused on the outcomes of gallstone disease during pregnancy in an Australian setting. During pregnancy, gallstone disease was associated with adverse maternal and neonatal outcomes. Conservative management was done in most of the women with gallstone disease during pregnancy. However, surgical management was associated with decreased risk of readmission.

Methods

• In this study, linked hospital, birth, and mortality data for all women with singleton pregnancies in New South Wales, Australia, 2001–2012 were evaluated.
• Exposure of interest was gallstone disease (acute biliary pancreatitis, gallstones with/without cholecystitis). 
•  Outcomes including preterm birth (spontaneous and planned), readmission, morbidity and mortality (maternal and neonatal) were compared between pregnancies with and without gallstone disease.
• With the aid of modified Poisson regression and adjusted for maternal and pregnancy factors, adjusted risk ratios (aRRs) and 99% confidence intervals were determined.

Results

• Out of 1 064 089 pregnancies, 1882 (0.18%) had gallstone disease.
• Of these, 239 (12.7%) had an antepartum cholecystectomy and 1643 (87.3%) were managed conservatively.
• Of those managed conservatively, 319 (19.0%) had a postpartum cholecystectomy.
• Findings displayed that gallstone disease was associated with increased risk of preterm birth (aRR 1.3, 99% CI 1.1, 1.6), particularly planned preterm birth (aRR 1.6, 99% CI 1.2, 2.1), maternal morbidity (aRR 1.6, 99% CI 1.1, 2.3), maternal readmission (aRR 4.7, 99% CI 4.2, 5.3), and neonatal morbidity (aRR 1.4, 99% CI 1.1, 1.7).
• Surgery was associated with decreased risk of maternal readmission (aRR 0.4, 99% CI 0.2, 0.7).