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Celiac Disease & Pregnancy: Everything You Should Know

Published:
Sep 2, 2020
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Updated:
Jun 4, 2021
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Contributor:
Erica Dermer
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13 minutes
Written by

Medically reviewed by

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Stefano Guandalini, MD
Stefano Guandalini, MD
Professor Emeritus at University of Chicago
Dr Guandalini is the former chief of pediatric gastroenterology, hepatology and nutrition at the University of Chicago, founder of the University of Chicago Celiac Disease Center and head of the clinical advisory team at imaware™.
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If you’re pregnant and have celiac disease (CD), it’s crucial to put certain precautions and measures in place to ensure you deliver a healthy baby. It’s a no-brainer to put your nutrition, health and overall well-being on the front burner when you’re expecting. After all, you are eating for two, which means you need to consume plenty of minerals, vitamins, and other nutrients. This can become quite difficult when you are wrestling with nausea, headaches, food cravings, and other symptoms of morning sickness.

Having celiac disease can make it even more challenging because you must be extremely careful about what goes into your body. Even more complicated is that research has shown that women with celiac disease suffer from pregnancy complications and problems at greater rates than those without the disorder. More specifically, untreated celiac disease may elevate the risk of miscarriage, infertility, preterm births, stillbirths, and low birth weights. Because it has no specific cure, the best and only way to treat CD, whether you are pregnant or not, is to embrace a lifelong, strict zero-gluten diet. When you do, these risks all but go away.

Unfortunately, a gluten-free diet may well be low in nutrients that are essential for a healthy pregnancy, including magnesium, iron, vitamin D, zinc, fiber, B vitamins, and calcium. So, being pregnant and having celiac disease can be a complicated time.

Keep reading this article to learn everything you need to know about being pregnant with celiac disease ⁠— from how celiac disease may affect your pregnancy to you are recommended to eat.

What’s Celiac Disease?

Celiac disease is an autoimmune disorder in which a person reacts to consuming gluten, a type of protein that is found in rye, barley, wheat, and their hybrids. If left untreated, an extended immune reaction to gluten causes severe inflammation which gradually destroys the inner lining of the small intestine. In particular, celiac disease damages the villi, millions of finger-like projections on the small bowel’s lining. These villi help to absorb nutrients into the body. Through damage to the villi, celiac impairs proper absorption of vitamins, minerals, and other nutrients, and creates nutrient malabsorption in medical terms.

Even though it was previously thought to be a malabsorptive children’s disorder, celiac disease can develop at any age and can affect anyone regardless of their gender or race.

NIH says about three million Americans have celiac disease, which translates to roughly 1 percent of the U.S. population. There’s no specific known cause of celiac disease, but genetic predisposition, environmental factors, and risk of other autoimmune disorders all play a role.

The classic symptoms are diarrhea, excess gas, bloating, sometimes constipation and other digestive complications. However, many, and perhaps even the majority of,  people with celiac disease may experience non-gastrointestinal symptoms that include fatigue, weight loss, headaches, osteoporosis, iron-deficiency anemia, dental enamel defects, and vision problems. Some patients may also get what’s known as silent celiac disease, in which they show insignificant or no symptoms at all, yet their intestine is damaged. Because celiac disease manifests in very different ways, it’s often misdiagnosed or goes undiagnosed for years, causing serious health complications, including severe malnutrition, chronic fatigue and even, in some cases, cancer.

 

Recent research and medical studies seem to suggest that there’s an established connection between untreated celiac disease and pregnancy complications in women. It’s been linked to low fertility, stillbirths, low birth weights, miscarriages, preterm labor, and shorter breastfeeding periods, among other gestational disorders. Most of these issues however may occur if the pregnancy is ongoing while not yet being gluten-free: if the celiac diagnosis occurs before pregnancy and a strict gluten-free diet is promptly instituted and carried out, then these complications do not occur at rates higher than the general, healthy population.

Find out more in our guide to the symptoms, causes, diagnosis and treatment options for celiac disease.

Life with Celiac Disease

Living with celiac disease means you are constantly worried about what goes into your body. Whether you are at work, in school, eating out with friends or preparing a meal at home, you must be continuously mindful of your nutrition. Don’t forget that if you are celiac and consume anything with gluten – whether that’s a beer, or a sandwich, your immune system will most likely go to war with your small intestine. The only way to stop this and enjoy a peace of mind is to maintain a strict gluten-free diet. Whether or not you are pregnant, you should make sure that your meals, medications, drinks, supplements, and so forth are devoid of gluten.

And remember, early diagnosis and treatment can make a massive difference. More importantly, be sure to first get tested for celiac disease before you embrace a gluten-free lifestyle. One reason for this is that most gluten-rich foods are loaded with dietary fiber, vitamins, and minerals that you don’t want to miss on just a hunch. 

 

How Does Celiac Disease Affect Pregnancy?

Celiac disease may affect your pregnancy through two primary mechanisms:

  1. Nutritional deficiency: In this pathway, celiac disease impairs your body’s ability to absorb vitamins, minerals, and other key nutrients. This means your body may not get enough iron, selenium, B vitamins, vitamin D, zinc, and folate, all of which are required for the growth and development of the fetus.
  2. Autoimmune mechanism: Certain antibodies (immune biochemicals) that your body produces may affect your pregnancy if you have celiac disease. They may do so in two possible ways.

In the first instance, anti-transglutaminase (tTG) autoantibodies produced by celiac patients when they eat gluten, are thought to bind to the placenta and damage it, causing pregnancy complications like spontaneous abortion or miscarriage.

In the second possibility, the tTG antibodies are thought to cause damage to the endometrial microvascular endothelial cells (HEMEC). These are special uterine cells that play a role in the menstrual cycle regulation. When HEMECs are harmed, this may lead to preterm labor, threatened miscarriage, and other pregnancy disorders

 

What Does The Science Say?

In this 2014 meta-review published in the journal Human Reproduction Update, researchers also reviewed studies that looked at the potential link between celiac disease and several different reproductive disorders. Dr. Chiara Tersigni and her team made two findings: 

  1. That celiac disease may be linked with several reproductive problems. 
  2. This relational risk is significantly reduced once the person goes on a gluten-free diet. 

For example, the reviewers discovered that women with undiagnosed or untreated celiac disease experienced shorter breastfeeding periods and lower fertility lifespans. The meta-review also revealed that untreated celiac disease may also affect fertility rates in women. This is corroborated by a series of scientific studies carried out before and after this review.

For example, in another 2016 meta-analysis published in the Journal of Clinical Gastroenterology, scientists found that unexplained infertility and “all-cause” infertility were more prevalent in celiac women than in the general population. 

Pregnancy in general, not just in untreated celiac women, carries the potential for several different complications and problems. Preterm delivery, iron-deficiency anemia, miscarriage, and chronic fatigue are all potential risks of pregnancy though most women have uncomplicated gestations and deliveries. Unfortunately, women with celiac suffer from these pregnancy complications and problems at a much higher rate than healthy non-celiac women. In fact, stillbirths, low baby birth weights, miscarriage, preterm labor, and other pregnancy complications have been found to occur at 2-4 times the rate of non-celiac women. And there are several clinical and research studies that seem to concur.

A great example is one case-control study published in 2010 in the journal BMC Gastroenterology, in which researchers investigated 62 Italian women with celiac disease. Upon extensive interviews, scientists found that 65 percent of women with celiac disease reported at least one pregnancy-related disorder. This is as opposed to 31 percent of non-celiac women who were studied as controls. But please note that 85 percent of the participants were diagnosed with celiac after their first pregnancy and therefore were untreated prior to getting pregnant.

Here are a few highlights of the study:

  • Intrauterine growth restriction (IUGR) was shown to affect over 6 percent of women with celiac disease, compared to zero amongst control subjects. IUGR is an uncommon pregnancy complication in which the fetus is smaller than it should be because it’s developing at a slower rate inside the uterus. It’s directly linked to low birth weight and often to fetal development disorders.
  • Approximately 41 percent of women with celiac disease had serious iron-deficiency anemia during pregnancy, compared to only 2 percent in control subjects.
  • Placental abruption was seen in 18 percent of celiac women, as opposed to 1 percent of control subjects. This is a dangerous pregnancy complication in which the placenta (the organ a woman creates to supply oxygen and nutrients to the fetus) starts to separate from the uterine wall.
  • Uterine hyperkinesia–abnormally frequent uterine contractions during labor that can cause complications–were noted in 10 percent of the celiac women and none of the control participants.
  • Threatened miscarriage, also known as threatened abortion, which is unexplained vaginal bleeding during the first 20 weeks of pregnancy, was reported in 39 percent of celiac women, compared to only 9 percent of control subjects.
  • Pregnancy-induced hypertension affected 10 percent of celiacs and none of the non-celiac controls. Also called gestational hypertension, this is a pregnancy complication that’s characterized by high blood pressure.

Other medical studies suggest that may be a link between having celiac disease and low birth weight. For instance, in a 2014 study, scientists found that the risk for low birth weight is much higher in undiagnosed celiac women than those who have started a gluten-free diet.

Researchers also noted that undiagnosed celiac women typically have shorter pregnancies, with some giving birth up to 14 days before the scheduled date.

Research shows that C-sections births tend to occur more in celiac women than non-celiac counterparts. This is significant because some studies have shown that children born via cesarean section may themselves have a higher risk of getting celiac disease later in life.

It is crucial however to note that the vast majority of these pregnancy complications and problems may disappear, become less severe, and do not recur once the person goes on a gluten-free diet.

So, the key is to jump on the gluten-free bandwagon as soon as celiac disease is diagnosed.

Accordingly, in one 2005 Indian study, scientists concluded that doctors and OBGYNs should consider testing for celiac disease in women with unexplained pregnancy complications, problems, and other reproductive disorders. This way, those confirmed to be celiac can adhere to a gluten-free diet, reducing the possibility of risk to the fetus.

Can Celiac Disease Cause Miscarriage?

Yes. Research shows that celiac women may be at an increased risk of miscarriage than women without the disorder, especially if it’s left untreated or undiagnosed for a long time. For example, in the aforementioned Italian study, scientists found that 85 percent of celiac women who miscarried had done so before they were diagnosed. Several other studies have confirmed this association as well as the important fact that the gluten-free diet is able to substantially reduce the risk of abortion

Wondering how celiac disease causes miscarriage? Some studies suggest that the autoimmune response triggered by gluten in celiac women may be responsible for this. To be clearer, scientists suggest that this may happen when tTG antibodies from celiac bind to the fetus and cause damage to the placenta, leading to placental abruption.

Can You Get Celiac Disease While Pregnant?

Yes, women may get celiac disease while pregnant. But let’s get one thing straight: celiac disease can develop at any age, and for some women, the onset could be following a pregnancy. In fact, recent research seems to suggest there may be a tentative connection signifying pregnancy might actually play some role in celiac development.

Don’t get it wrong, though. That doesn’t imply that pregnancy in and of itself causes celiac disease. Some experts believe that celiac disease needs a “trigger” to develop. That may be an environmental factor, life event or health issue that causes your immune system to suddenly “see” gluten as a foreign or toxic substance. In some way, pregnancy may be associated with some major life events and health complications such as miscarriage, emotional trauma,  infections, high blood pressure, and C-section surgery, all of which may trigger celiac disease.

Can Pregnancy Make Celiac Disease Worse?

Yes – pregnancy may worsen symptoms of an undiagnosed and untreated celiac disease. Because pregnancy requires plenty of selenium, folic acid, zinc, B vitamins, and other minerals, celiac disease - by causing inadequate absorption of such nutrients - may make it worse. It so happens that the opposite is also true – pregnancy may make constipation, gas, headaches, fatigue, iron-deficiency anemia, and other CD symptoms worse. In one 2013 study published in the journal Nature, researchers noticed that 20 percent of women with celiac disease experienced more severe celiac symptoms like stress, while non-celiacs reported no such observation.

What Can You Eat During Pregnancy If You Suffer from Celiac Disease?

Your unborn child’s health and well-being are linked to your own, which is why you need to stay on top of your nutrition. However, the restrictive nature of a gluten-free diet can significantly limit your nutrition. If you are on a zero-gluten diet, the odds are high that you won’t get enough folic acid, zinc, selenium, magnesium, vitamin D, fiber, and iron. But these micronutrients are vital during pregnancy. Consult with your primary care physician, OBGYN, and dietitian to design a meal plan that’ll make sure that you get plenty of vitamins and minerals, all while staying away from gluten.

Generally speaking, here’s what you need to eat when you are pregnant with celiac disease:

  • Folic acid: It’s required particularly during the first trimester. Folic acid is needed for building healthy cells, and it helps prevent the development of defects in your unborn baby. You can get plenty of folic acid by loading up on broccoli, citrus fruits, peanuts, dark leafy greens, asparagus, avocado, and beans, especially black, pinto & lentils. Unfortunately, most gluten-free food products aren’t fortified with folic acid, so you have to supplement during pregnancy.
  • Zinc and Copper: Both minerals are essential for pregnancy and fertility in women. During pregnancy, eat cashews, yogurt, beans, pork, beef, and oysters because they are rich in zinc and copper.
  • Iron: eggs, lamb, beef, dark leafy greens, broccoli, peas, and sweet potatoes are rich in iron. Even though meat boasts twice to thrice more iron than fruits/veggies, you need vitamin C because it helps in the absorption of iron and folic acid.
  • Omega-3 fatty acids: It’s important for the brain development of your child. Take sardines, lake trout, tuna, salmon and other oily fish as they’re all rich in omega-3 fatty acids. Ensure that your fish is mercury-free. Otherwise, you can use supplements.
  • Magnesium, Vitamin D and Calcium: Pregnancy can take a toll on your bones. You need these vitamins and minerals to improve your bone density. If you are lactose intolerant, you may drink lactose-free milk and be sure to take plenty of leafy greens, calcium-fortified drinks, and canned fish.

Summary

Managing celiac disease when you are pregnant can be challenging.

Going on a strict gluten-free diet helps address symptoms of celiac disease and prevent further damage to your body. However, this diet may be short on critical vitamins and nutrients for pregnancy, such as iron, folic acid, magnesium, zinc, and vitamin D.

Celiac damage on the small intestine also causes malabsorption of these nutrients. Celiac disease may affect your pregnancy as well. If left untreated, celiac disease may increase your chances of developing serious pregnancy complications and problems, ranging from miscarriage and infertility to low birth weight and preterm delivery. These risks differ depending on whether a woman has been diagnosed with celiac prior to pregnancy. The sooner you get confirmation of celiac, the earlier you go on a gluten-free diet, preventing more possible complications.

If you have celiac disease, you must eat a diet rich in folic acid, calcium, magnesium, zinc, iron, and omega-3 fatty acids. Make sure you load up on leafy greens, fish without mercury, beans, broccoli, citrus fruits, and spinach.

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