Cholecystectomy during pregnancy supported in large study

For expectant mothers with acute cholecystitis (AC), undergoing cholecystectomy lowers the risk of adverse pregnancy outcomes, according to a large study.

The study included 5,759 pregnant women with AC (mean age 30.1 years) and 23,036 propensity score-matched pregnant women without AC (control; mean age 29.9 years). Researchers estimated the treatment-associated risk of adverse pregnancy outcomes over 1 year of follow-up.

A total of 1,182 out of 3,426 pregnant women with AC (34.5 percent) underwent cholecystectomy during the pregnancy. The procedure was performed during the first trimester in 684 women (41.7 percent), during the second trimester in 404 women (40.4 percent), and during the third trimester in 94 women (12.0 percent).

AC during pregnancy, regardless of treatment, raised the likelihood of adverse pregnancy outcomes across all trimesters (odds ratio [OR], 1.69, 95 percent confidence interval [CI], 1.54–1.85).

However, the likelihood of adverse pregnancy outcomes decreased with cholecystectomy versus nonoperative management (OR, 0.75, 95 percent CI, 0.63–0.87). This advantage was consistently observed regardless of when the procedure was performed (first trimester: OR, 0.81, 95 percent CI, 0.66–1.00; second trimester: OR, 0.71, 95 percent CI, 0.50–1.00; third trimester: OR, 0.45, 95 percent CI, 0.28–0.70).

The results back the recommendation that cholecystectomy be performed to manage AC during pregnancy and should inform decision-making discussions.