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Pregnant With Celiac Disease: Signs, Diagnosis And Prevention

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Celiac disease (coeliac disease) is an autoimmune condition in which the body is sensitive to gluten. If you are pregnant with celiac disease and miss timely management, it could lead to poor pregnancy outcomes (1). Clinicians advise diagnosis of the condition to all women with unexplained infertility since the incidence of celiac disease is high (2). Genetic factors and several external factors could be the risk factors. Read on to know about the causes, risk factors, signs, and ways to prevent celiac disease during pregnancy.

What Are The Signs And Symptoms Of Celiac Disease During Pregnancy?

Celiac disease during pregnancy is usually asymptomatic. However, pregnant women intolerant to gluten and who continue having gluten in their diet may show various signs and symptoms of celiac disease during pregnancy (2) (3).

  • Infertility
  • Abdominal pain
  • Swelling and bloating
  • Diarrhea
  • Weight loss
  • Fatigue
  • Irritability
  • Joint pain
  • Skin rash

How Does Celiac Disease Affect Pregnancy?

Pregnancy associated with celiac disease might have further complications. According to the Celiac Disease Foundation, women with celiac disease might have reduced fertility and shorter breastfeeding timelines (4).

There are limited studies on what causes pregnancy complications with celiac disease. However, a study on metadata analysis suggests two possible mechanisms towards the health element (3) (4) (5).

  1. Nutritional deficiency: Consuming a gluten-rich diet during celiac disease may damage the inner lining of your small intestine. The body reacts to the gliadin protein present in the gluten. It activates a cascade of the immune response towards millions of villi, the finger-like projections in the intestine.

The damaged villi become incapable of essential nutrient absorption. There may be a deficiency of zinc, selenium, and folic acid, essential during pregnancy. Your body might start showing symptoms of nutrient deficiency.

  1. Autoimmune mechanisms: The anti-transglutaminase (tTG) antibodies, which are only found with patients with active celiac disease, might cause complications during pregnancy. The metadata analysis suggests the tTG antibodies might cross-react and bind to the trophoblast layer of the embryo during pregnancy. The antibodies might also harm the cytoskeleton of the endometrial cells of the mother. All of this would restrict embryo implantation and can cause poor pregnancy outcomes.

What Are The Risk Factors Associated With Celiac Disease?

Some risk factors for celiac disease are (6) (7):

  • Genetic factors: Several genetic links have been traced to the origin of celiac disease. Also, high risk is seen among monozygotic teens.
  • Infant feeding and weaning practices: A high amount of gluten during weaning might be a risk factor.
  • Gluten introduction timing: Gluten introduction at a later age may elevate the risk of acquiring the disease.
  • Environmental factors: Although celiac disease has a genetic origin, research re-affirms the influence of environmental factors in acquiring the disease. Those born during summer or spring are more prone to acquiring celiac disease than those born in winter or autumn.
  • Cesarean section (C-section): According to The University of Chicago Celiac Disease Center, a C-section might play a role in acquiring celiac disease in women genetically predisposed to the disease (8).

The belief that a C-section can contribute to acquiring celiac disease is based on a baby’s acquired immunity. Some study suggests cesarean delivery may limit the baby’s exposure to maternal vaginal flora (6) (9). Many researchers think acquiring maternal microbiota (mother’s microbial population) is vital for developing a healthy immune system in the baby, which stays lifelong (9).

However, there is a difference in opinion in the scientific community on whether a c-section delivery might play a role in acquiring the celiac disease. A multimodal study suggests c-section do not increase the risk of acquiring celiac disease more than vaginal delivery (6).

What Are The Pregnancy-Related Complications Of Celiac Disease?

Women having reproductive problems or issues of infertility may consider the tests for the diagnosis of celiac disease. Those who adhere to a management plan may gain fertility within a few months. Some of the complications associated with pregnancy in women with untreated celiac disease are (10) (11) (12):

  • Babies with reduced birthweight
  • Preterm birth
  • Placenta abruption
  • Uterine hyperkinesia
  • Intrauterine growth restriction

How Is Celiac Disease Diagnosed?

The diagnosis of celiac disease is based on the following medical examinations (13) (14) (15):

  • Genetic testing: It may be done to understand your predisposition to celiac disease.
  • Serological tests: Some of the antibody-based serological diagnostic tests required for the identification of celiac disease are total IgA, IgA-tTG, IgA-EMA and IgG/IgA-DGP.
  • Intestinal biopsy: It is considered to be the most accurate way of diagnosing celiac disease.

If You Have Celiac Disease, Will Your Baby Have It Too?

Celiac disease is linked to a few genetic factors. If you or your partner have celiac disease, your baby might be at higher risk of acquiring the celiac disease. Even if your baby has the genes, the disease may not be actively manifested unless exposed to gluten in the diet. Exposure to gluten in the diet for six months to a year is required for the disease to manifest in a genetically predisposed individual (16).

Your doctor can ascertain the risk by conducting genetic tests for your baby. If the genetic test results are negative, your baby might not be predisposed to acquiring celiac disease.

According to the Center for Celiac Disease at The Children’s Hospital of Philadelphia, in most cases, genetic factors are not solely responsible for the pathogenicity of the disease. Instead, both genetic factors and the abnormal immune system are responsible for the manifestation of the disease in infants.

How Is Celiac Disease During Pregnancy Prevented?

The following measures could help prevent acquiring celiac disease during pregnancy (17):

  • Early diagnosis could help you stay away from severe symptoms of celiac disease. If your parents or relatives have an incidence of celiac disease, seek advice from a doctor. You may go for antibody-based serological tests before you plan for pregnancy.
  • Get all the scheduled prenatal checkups.
  • Adhere to a strict no-gluten diet.

Frequently Asked Questions

  1. Can pregnancy worsen the celiac disease?

Pregnancy with untreated celiac disease can worsen the disease symptoms. Since there is a heightened demand for nutrients and minerals such as selenium, folic acid, zinc, and B vitamins in pregnancy; celiac disease can cause inadequate absorption of these nutrients, resulting in further health complications (4).

  1. Does celiac disease go away with pregnancy?

Celiac disease may not go away with pregnancy. However, maintaining a gluten-free diet can help you avoid any adverse effects of celiac disease (18).

Celiac disease is an autoimmune disease triggered by the presence of gluten in the diet. Although the disease can cause complications in pregnancy, the adverse effects can be easily managed by following a strict no-gluten diet. A timely diagnosis and management plan can help reduce the disease symptoms and adversaries.

References:

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  1. Reproductive life disorders in Italian celiac women. A case-control study.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928757/
  2. Pregnancy and Celiac Disease.
    https://www.beyondceliac.org/living-with-celiac-disease/womens-health/pregnancy-and-celiac-disease/
  3. Celiac Disease and Pregnancy.
    https://badgut.org/information-centre/a-z-digestive-topics/celiac-disease-pregnancy/
  4. How Celiac Disease Affects Pregnancy.
    https://celiac.org/about-the-foundation/featured-news/2014/09/celiac-disease-affects-pregnancy/
  5. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms.
    https://pubmed.ncbi.nlm.nih.gov/24619876/
  6. CAESAREAN SECTION ON THE RISK OF CELIAC DISEASE IN THE OFFSPRING: THE TEDDY STUDY.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787038/
  7. Risk factors for celiac disease
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4535670/
  8. Could a c-section activate celiac disease in someone with the gene?
    https://www.cureceliacdisease.org/faq/could-a-c-section-activate-celiac-disease-in-someone-with-the-gene/
  9. The prenatal gut microbiome: Are we colonized with bacteria in utero?
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583026/
  10. The impact of maternal celiac disease on birthweight and preterm birth: a Danish population-based cohort study.
    https://pubmed.ncbi.nlm.nih.gov/19939833/
  11. Reproductive life disorders in Italian celiac women. A case-control study.
    https://pubmed.ncbi.nlm.nih.gov/20691041/
  12. Infertility and Celiac Disease.
    https://www.beyondceliac.org/celiac-disease/related-conditions/infertility/
  13. Testing & Diagnosis in Women.
    https://www.beyondceliac.org/living-with-celiac-disease/womens-health/testing/
  14. Growing up gluten-free: The best treatment for kids with celiac disease.
    https://utswmed.org/medblog/gluten-free-celiac-kids/
  15. Diagnosis of Celiac Disease.
    https://www.cureceliacdisease.org/diagnosis/
  16. Celiac Disease and Unborn Children.
    https://www.beyondceliac.org/living-with-celiac-disease/info-for-parents/ask-the-pediatric-gastroenterologist/celiac-disease-and-unborn-children/
  17. Early diagnosis of coeliac disease in the Preventive Youth Health Care Centres in the Netherlands: study protocol of a case-finding study (GLUTENSCREEN).
    https://www.medrxiv.org/content/10.1101/2021.04.24.21254842v1.full
  18. Treatment – Coeliac disease.
    https://www.nhs.uk/conditions/coeliac-disease/treatment/
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Anshuman Mohapatra

Anshuman Mohapatra is a biotechnology scientist with more than six years of research experience in analytical chemistry and biotechnology. He has submitted his Ph.D thesis at the Indian Institute of Technology Guwahati (IIT Guwahati) and served as a research fellow (JRF/SRF) during his Ph.D tenure. His research interest includes analytical chemistry, neurobiology and lipid disorder diseases. Three of his research... more