Celiac Disease is an autoimmune disorder that affects 1% of the population. This occurs when the body reacts negatively to gluten, a protein found in wheat, barley, rye, and other grains. When individuals with celiac disease consume gluten, it causes damage to the small intestine and interferes with the absorption of nutrients.
Celiac Disease can have significant health implications during a pregnancy. It is important for those who are pregnant or planning to get pregnant to explore any potential symptoms of celiac disease, or to discuss with your doctor about testing if you have a family history of celiac disease prior to testing. If you have already been diagnosed with celiac disease, it is important to ensure that you are managing it properly in order to have a healthy pregnancy.
This article will discuss the following:
- What are the symptoms of celiac disease?
- How do you diagnose celiac disease during pregnancy?
- How do you manage celiac disease during pregnancy?
- What nutrient deficiencies are common in celiac disease that could impact pregnancy?
- What are the risks of not managing celiac disease during pregnancy?
Symptoms of Celiac Disease
The symptoms of celiac disease can vary greatly from person to person which can make a diagnosis challenging. Common symptoms of celiac disease include the following:
- Abdominal pain
- Malnutrition (most commonly, iron, zinc, vitamin D, and vitamin B12)
During pregnancy, symptoms can change and become more or less severe. They can also be misinterpreted as pregnancy symptoms, as many women experience unpleasant symptoms during pregnancy, especially digestive changes and disturbances. In addition to the symptoms listed above, Women with celiac disease may experience the following additional symptoms during pregnancy:
- Severe Fatigue
- Failure to gain adequate weight
Diagnosing celiac disease prior to or during pregnancy is important to carrying a healthy pregnancy so that a woman can be properly nourished and provide adequate nutrition to her growing baby.
Diagnosis Of Celiac Disease In Pregnancy
If you suspect you may have celiac disease or have a family history of celiac disease, we encourage you to get tested by one of the following methods:
- Genetic Testing: Genetic testing is a highly accurate look at your genes to understand whether you are predisposed to gluten sensitivity. Learn more about genetic testing here, as well as the limitations of other testing.
- Blood Testing: A blood test is available that checks for certain antibodies. People with celiac disease who eat gluten produce antibodies in their blood because their immune systems view gluten as a threat. It is important to note that you must be on a gluten-containing diet for antibody blood testing to be accurate.
- Endoscopy: An endoscopy is when a tube is inserted down your throat so that a practitioner can look at your small intestine for inflammation or damage. They may also take a small biopsy of your intestines. Like blood testing, you must be eating a diet that contains gluten for this test to be accurate.
Early diagnosis is crucial to ensure that a woman can start an appropriate gluten free diet and address any nutrient deficiencies, and so that both mother and baby can thrive.
Managing Celiac Disease During Pregnancy
The best way to manage celiac disease during pregnancy is through maintaining a strict Gluten-Free diet. This means avoiding all foods that contain gluten, such as bread, pasta, and baked goods. It is also important to be aware of foods with “hidden gluten” like other grains, condiments, and sauces.
The good news is that the nutrients that a woman needs during pregnancy are generally not found in gluten containing foods. Instead, they are found in naturally gluten-free healthy whole foods like eggs (choline), grass-fed meats (B vitamins, zinc, and iron), leafy greens (folate), fatty fish (omega-3s), berries (vitamin C), nuts and seeds (magnesium), and more. We have a comprehensive list of healthy gluten free foods here.
Since many people with celiac have lingering vitamin deficiencies, even after adopting a gluten free diet, women with celiac disease should also monitor their nutritional status, ensuring they are getting all the necessary vitamins and minerals for a healthy pregnancy.
Nutritional deficiencies are a common side effect of gluten and undiagnosed celiac disease and a common cause for pregnancy complications. The following are common gluten induced nutrient deficiencies and their corresponding impact on pregnancy outcomes:
- Vitamin D: Vitamin D deficiency in pregnancy is associated with dental enamel defects, increased rates of cavities and dental issues, lower bone density, and higher rates of fractures in children. Vitamin D deficiency is also associated with increased incidence of preeclampsia in pregnant women.
- Folate: Folate deficiency in pregnancy is associated with neural tube defects, including spina bifida, anencephaly, and others.
- Vitamin B12: Vitamin B12 supports fetal cognitive and neurological development in pregnancy and deficiencies can have lasting impacts.
- Iron: Iron deficiency during pregnancy can cause fatigue in the mother, thyroid imbalances and insufficient weight gain in both mother and baby, and developmental delays in the baby.
- Zinc: Zinc deficiency in pregnancy is associated with low birth weight which can lead to a number of other health complications for a child
This list is of course not comprehensive, and pregnant women are at risk for developing other nutritional deficiencies as well. Other examples include: Calcium, magnesium, selenium, copper, chromium, vitamin A, vitamin K, vitamin E, and Omega-3 fatty acids.
Even with proper management of celiac disease, food alone often isn’t enough during pregnancy. Nutrient needs are increased as a woman is nourishing for two, so a high quality gluten free prenatal vitamin supplement along with a balanced omega 3 is recommended.
Risks Of Not Managing Celiac Disease During Pregnancy
One might wonder what would happen if celiac disease is not managed during pregnancy. Perhaps a woman does not know that she has celiac disease so she doesn’t know that it needs to be managed. Or perhaps she is aware of her diagnosis but faces strong cravings or feelings of morning sickness that make it a challenge to avoid foods that contain gluten.
Celiac disease during pregnancy involves both risks to the mother and to the baby.
Risks to the Mother
Risks to the mother of unmanaged celiac disease during pregnancy may cause complications such as miscarriage, preterm delivery, and low birth weight. The good news is that research suggests that this increased risk of unfavorable outcomes dissipates after 6-12 months of a gluten free diet.
Risks to the Fetus
Risks to the fetus include increased incidence of intrauterine growth restriction (IUGR) and developmental delays. In addition, there are risks to the baby once born. Gluten induced nutritional deficits during pregnancy have been linked to low birth weight, lower IQ, smaller head circumference, increased risks of infection, mental retardation, failure to thrive, and much more.
With such significant risks if not managed, proper management of celiac disease during pregnancy is vital to the health of both mother and baby.
Pregnancy is among the most nutritionally demanding times in a woman’s life. It is critical to the health of herself and her baby that she gets sufficient vitamins and minerals for her own ongoing health and pregnancy outcomes, as well as for the proper growth and development of her baby.
If you are thinking about trying to conceive, or if you are currently pregnant and think you might be sensitive to gluten, we encourage you to take the sensitivity test!