Objective: To review the etiological characteristics and prognosis of acute pancreatitis during pregnancy (APP) as well as its changing trend in the recent 20 years, and investigate the essentials for the clinical diagnosis and treatment of this condition. Methods: The clinical data of 52 APP patients treated in Xiangya Hospital of Central South University over the recent 20 years (1994 to 2013) were retrospectively analyzed. Results: Of the 52 APP patients, 3 cases occurred in early pregnancy (5.8%), 12 cases occurred in mid-pregnancy (23.0%) and 37 cases occurred in late pregnancy (71.2%); 26 cases (50.0%) were mild pancreatitis, 13 cases (25.0%) were moderately severe pancreatitis and 13 cases were severe pancreatitis (25.0%). As for the causes of APP, 28 cases (53.8%) were hyperlipidemic pancreatitis, 14 cases (27.0%) were biliary pancreatitis and 10 cases (19.2%) were idiopathic pancreatitis. In the entire group, the maternal death was 0, but the fetal mortality reached 19.2% (10/52), which included 2 cases of intrauterine death, 4 cases of neonatal distress after premature delivery and 4 cases of artificial abortion on consideration of the potientially adverse effects exerted by medication. Conclusion: The prevalence of APP has shown an increasing trend in recent 20 years, and most of the cases occur in late pregnancy. Hyperlipidemia and especially biliary disease are the main causes for APP. APP is still associated with relatively high fetal mortality, and further standardized therapy and enhanced perinatal care are of important value for improving the overall outcome of APP.