Celiac Disease and Pregnancy

It is estimated 1 out of every 80 women have celiac disease, many without realizing it. Celiac disease is common enough that some doctors and researchers feel celiac screening should become part of the routine prenatal blood tests performed at the beginning of a pregnancy. If left untreated, the mixture of celiac disease and pregnancy can lead to the loss of a pregnancy, low-birth weights and birth defects.

What is Celiac Disease?
Celiac disease is an autoimmune disorder involving the digestive system. An autoimmune disorder is when the immune system creates antibodies that attack the body instead of a foreign invader. In the case of celiac disease, the antibodies are created in response to a sensitivity to the protein gluten (found in grains such as wheat, rye, barley and oats) and they attack the intestinal tract lining. The intestinal lining has several small hair-like structures called villi that absorb the nutrients from food. During the attack by the antibodies, the villi become damaged and can no longer absorb the nutrients required by the body. This leads to the individual becoming malnourished.

Symptoms of celiac disease include:
Chronic diarrhea or constipation (possibly both)
Abdominal pain
Bloating and gas on a regular basis
Foul smelling stools that are pale in color
Weight loss
Anemia
Muscle cramps, joint pain, bone pain
Depression
Irritability
Fatigue
Weakness
Mouth sores
Missed menstrual periods
Miscarriage
Infertility
Some people with celiac disease develop an itchy, blistering skin rash (dermatitis herpetiformis). This most frequently occurs around the face, elbows, knees and on the buttocks.

Treatment for most people with celiac involves eating a gluten-free diet. If gluten is not introduced into the body, antibodies will not be made and therefore no damage can be done. The villi will generally heal after six months and the body will again be able to absorb nutrients.

Celiac Disease and Pregnancy: Folic Acid
The initial concern of many who have been diagnosed with celiac disease during their reproductive years is the lack of folic acid intake. This could be due to a gluten-free diet that does not contain fortified grain products or the nutrient not being absorbed by damaged villi. As folic acid helps prevent neural tube defects (birth defects of the brain and spine, such as spina bifida and anencephaly) by up to 70%, this is a valid concern. One study showed 1 out of 60 cases of babies born with neural tube defects involved a mother who had celiac disease.

The recommended daily amount of folic acid is 400 mcg. A multi-vitamin or good prenatal vitamin will supply 100% of the recommended daily value. Ask your doctor or pharmacist for assistance in picking a brand that is safe for your gluten-free diet.

Folic acid is also be found in many foods, such as oranges and orange juice, leafy green vegetables, broccoli, asparagus, chickpeas, lentils, peas, and liver.

To help prevent neural tube defects, a gluten-free diet should be followed for 6-12 months prior to pregnancy. This should be combined with 100% of the recommended daily value of folic acid for at least 3 months before pregnancy.

Celiac Disease and Pregnancy: Pregnancy Complications
Recent studies have shown a link between celiac disease and several forms of pregnancy complications. In cases where the gluten-free diet was not followed, up to 21% experienced miscarriages, 16% had pregnancies involving fetal growth restriction (the fetus was smaller than expected for its gestational age), and the average birth weight was considerably lower than the babies of women who were gluten-free or did not have celiac disease. The studies also showed the average time for breastfeeding in women with untreated celiac disease was 2.5 times shorter than in other women.

Additional studies showed women with celiac disease who followed the gluten-free diet had a 35.6% drop in miscarriages and a 29.4% drop in babies with low-birth weights. They also were able to breastfeed longer. In most cases where the gluten-free diet was followed for 12 months before pregnancy, there was no noticeable difference between the women with celiac disease and those without it.

A person with one autoimmune disorder, such as celiac disease, has a higher chance of developing additional autoimmune disorders. Some of these may also cause issues with pregnancy. Whether other conditions are present or not, it is essential to follow the gluten-free diet if you wish to have the best possible pregnancy outcome when dealing with celiac disease.

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Sources:
The College of Family Physicians of Canada
Celiac Disease and Pregnancy - Kenneth F. Trofatter, Jr., MD, PhD - Healthline.com
Fertility and Pregnancy in Women with Celiac Disease by Michelle Melin-Rogovin - Celiac.com