Background <p>Diabetes associated with pancreatic calculi is called Fibro-Calculous Pancreatic Diabetes (FCPD) and it is rare in pregnant women, and management guidelines are not specified.</p> Case <p>A 28-year-old gravida 4 para1 live 0 abortion 2 was hospitalized with hyperemesis gravidorum at 6 + 6 weeks of gestational age. She was a known case of type I diabetes mellitus diagnosed at 16 years of age and was on insulin therapy since then. She was diagnosed to have pancreatic calculi in April 2023, just a month prior to this admission. She was given conservative management and her hyperemesis was controlled, but she had intractable pain abdomen and back pain which was not relived by analgesics, sedatives, and epidural analgesia. MRCP and MRI showed atrophic pancreas, pancreatic calculi in the main pancreatic duct, as well as small pancreatic ducts along with features of acute on chronic pancreatitis. ERCP was deferred by surgical and medical gastroenterologists due to pregnancy. The couple finally requested for MTP as she experienced similar pain during previous two pregnancies which was relieved after spontaneous pregnancy loss.</p> Result <p>MTP was undertaken with medical methods after which she had complete pain relief, and she was discharged with the advice to undergo ERCP before attempting next pregnancy.</p> Conclusion <p>Pain due to pancreatic calculi gets worsened during pregnancy and efforts should be made to treat pancreatic calculi prior to pregnancy and during pregnancy, and ERCP may be the modality of choice especially in women with recurrent pregnancy loss.</p>