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 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 is usually 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, sometimes called celiac sprue, 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 are suspected culprits.
The classic symptoms are constipation, diarrhea, excess gas, bloating, and other digestive complications. However, some people with celiac disease may experience non-gastrointestinal symptoms that include fatigue, weight loss, headaches, osteoporosis, iron-deficiency anemia, 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. Because celiac disease manifests in very different ways, it’s often misdiagnosed or goes undiagnosed for years, causing serious health complications, including severe malnutrition, ulcers, and chronic fatigue.
Recent research and medical studies seem to suggest that there’s an established connection between 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 disappear or are significantly reduced once the patient goes on a gluten-free diet, which is the mainstay (if not the only) treatment option for celiac disease.
Find out more about 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 prescription meds, 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 go on 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. The good news is that our new at-home blood testing kit makes the whole screening process painless, effortless, and hassle-free.
How Does Celiac Disease Affect Pregnancy?
Celiac disease may affect your pregnancy through two primary mechanisms — nutritional deficiency and autoimmune mechanism, according to Dr. Chiara Teringi, writing in Human Reproduction Update.
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.
Autoimmune mechanism: Certain antibodies (immune biochemicals) that your body normally 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) antibodies are thought to damage the placenta and bind to the embryo, 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
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: (i) that celiac disease may be linked with several reproductive problems. And, (ii)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 sprue 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 general population. Similarly, researchers of a 2014 study concluded that undiagnosed and therefore untreated CD may be a risk factor for infertility — but more research is required.
Pregnancy 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. Interestingly, 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 a rare 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 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 worth noting that the vast majority of these pregnancy complications and problems may disappear, become less severe, or are significantly managed once the person goes on a gluten-free diet.
Besides, it is important to keep in mind that undiagnosed or untreated CD may be correlated to serious pregnancy complications and disorders like miscarriage and infertility. So, the key is to jump on the gluten-free bandwagon sooner than later.
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.
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 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.
According to Mayo Clinic, celiac sprue may also become active after childbirth. So, if you have a genetic predisposition to get celiac disease — if you have gene variants HLA-DQ2 or DQ8, you may be at significant risk of developing the disease while pregnant. Note, however, that in some cases, it could just that symptoms begin to show at the time of pregnancy, and the person may have had CD well before the onset of the pregnancy.
Can Pregnancy Make Celiac Disease Worse?
Yes – pregnancy may worsen symptoms of celiac disease, particularly if it hasn’t been diagnosed. Because pregnancy requires plenty of selenium, folic acid, zinc, B vitamins, and other minerals, celiac disease 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, folic acid, 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:
(i) 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.
(ii) 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.
(iii) Iron: lamb, beef, dark leafy greens, broccoli, peas, sweet potatoes, and spinach are very 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.
(iv) 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.
(v) 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 have to stick with leafy greens, calcium-fortified drinks, and canned fish.
Managing celiac disease when you are pregnant can be a big challenge.
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. For instance, one Italian study showed that 65 percent of celiac women develop at least one pregnancy problem or reproductive disorder. 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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