Objectives: Gallstone-related disease is the second most common non-obstetric cause, following appendicitis, for acute abdomen in pregnancy. This study aimed to investigate treatment strategies, changes over time and outcome. Materials and methods: All consecutive patients with symptomatic gallstone-related disease during pregnancy admitted to Skane University hospital in Lund and Malmö 2001–2015 were analysed retrospectively. Information regarding the patient, pregnancy and fetus/child was recorded. The material was analysed by dividing it into two equal time periods and by comparing conservative management and surgical intervention. Results: We included 96 patients with 97 pregnancies. The age was 30 (26–34) years and BMI 28 (24–31). Median length of pregnancy at first admission was 23 (13–31) weeks. The three most common diagnoses were biliary colic (n = 63), cholecystitis (n = 22) and acute pancreatitis (n = 16). Conservative treatment was practiced in 62 (64%) patients and intervention in 35 (36%). Conservatively treated patients were admitted later during pregnancy (week 26 (20–33) versus 17 (10–22), p <.001). Surgically treated patients had a longer total length of stay (all admissions) than conservatively treated patients (p =.001), less readmissions (p =.001) and equal birth outcome. Surgical intervention was more common in the later time period (48% versus 22%, p =.011). Of the conservatively treated patients, 56% were subjected to surgical intervention within 2 years after delivery. Conclusions: We found that intervention was more common in the later time period, with good results concerning safety, and less readmissions. A majority of the conservatively treated patients had surgical intervention within two years after delivery. Our results support surgical intervention in pregnancy.