The hormone levels in the mother-to-be’s body change significantly during pregnancy, with progesterone and estrogen being the two main hormones that can cause many physiological changes, such as an increased incidence of GERD and constipation, which is a very common symptom among mothers-to-be. In the hepatobiliary system, the main change that occurs in the gallbladder is the chemical composition of the bile. In the middle and late stages of pregnancy, the gallbladder can increase in size to twice its pre-pregnancy size and the rate of gallbladder emptying is much slower. Therefore, the presence of gallbladder stones can be detected by ultrasound in up to 4% of pregnant women, but only about 1 in 1,000 presents with symptoms associated with gallbladder stones. In fact, the incidence of symptomatic gallstone disease during pregnancy is the same as that of non-pregnant women in the same age group. Gallstones that are asymptomatic do not warrant surgical management. However, it is not uncommon for mothers-to-be with gallstones to undergo cholecystectomy due to symptoms. The first most common surgical procedure performed on mothers-to-be is appendectomy, and the second most common is cholecystectomy. Biliary colic is a common symptom of gallstones, usually with a sudden onset of pain in the right upper abdomen or epigastrium, varying in severity, with severe pain, moaning and pale faces with profuse sweating. The pain is usually paroxysmal and can be constant. The pain can also radiate to the right shoulder or right upper back and is often accompanied by nausea and vomiting. There is no difference in the symptoms of biliary colic in pregnant and non-pregnant patients. Mothers-to-be who present with symptoms rely on ultrasound for clarification. The use of ultrasound is as accurate in determining gallstones as well as gallbladder inflammation in pregnant patients as it is in non-pregnant patients. The timing of cholecystectomy in expectant mothers with biliary colic depends on the gestational age and the severity of the symptoms. Surgery may not be considered for the first time if the symptoms are not severe, or if the symptoms resolve quickly with non-surgical treatment. Commonly used non-surgical treatments include bed rest, low-fat diet, anti-infection, antispasmodic and pain relief, and fluid support. If the condition has been combined with acute cholecystitis, surgery should still be seriously considered. The miscarriage rate after open cholecystectomy in early pregnancy is 12%, while it decreases to 5.6% and 0% in mid- and late pregnancy, respectively. The incidence of early onset contractions after cholecystectomy in mid-trimester is 0% and increases to 40% in late trimester, respectively. Therefore, the best time to perform cholecystectomy is the middle of pregnancy, when the incidence of spontaneous abortion and early contractions are lowest, except in cases where the patient has developed other complications of cholelithiasis. If the mother-to-be has gallbladder stones that are causing other more serious problems, such as obstructive jaundice, biliary pancreatitis, and cholangitis, surgery should be performed regardless of the early or late stage of pregnancy. Because many maternal and fetal problems are often caused by the disease itself, and because complications from nonsurgical treatment of gallstone disease can lead to higher maternal and fetal mortality, it is increasingly accepted that timely surgery can stop the progression of the disease. It has been reported that biliary pancreatitis in pregnant women can lead to 15% maternal mortality and 60% fetal mortality, so surgery is now the treatment of choice for gallstone disease in pregnancy. In addition, in general hospitals, there is a consultation with a professional obstetrician before the surgery for pregnant women to help the surgeon with the perioperative obstetric treatment, so mothers-to-be do not have to be afraid of surgery.