The Bottom Line

For women with celiac disease, a strict adherence to a gluten-free diet is vital and will help prevent serious problems during pregnancy. Health care providers (HCP) will monitor women with celiac disease for potential nutrient deficiencies.

However, engaging in a gluten-free diet without true, diagnosed celiac disease or gluten sensitivity has no proven health benefit during pregnancy. Specifically, there is no current evidence that a gluten-free diet during pregnancy avoids gluten or wheat allergies in children.

Further, eating a gluten-free diet for no specific health reason during pregnancy may increase the risk of the mother becoming deficient in certain nutrients, vitamins, and other minerals that could be significant during pregnancy.

Women should speak to their HCP if they suspect, or they are concerned they may have a gluten intolerance, as screening tests are readily available. If pregnant women wish to eat a gluten-free diet, they should also make sure their HCP is aware as their overall nutrition may need to be monitored or discussed.

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Background

Gluten proteins represent the major storage proteins of wheat, barley, and rye, which are in the endosperm of grains. Each type of grain contains differing amounts of gluten.

A gluten-free diet is necessary in patients diagnosed with gluten-related disorders, in which the body cannot digest these proteins.

A gluten free diet is also popular among individuals who perceive the diet as being healthy for various reasons, which is estimated to be one in every three and four Canadians and Americans, respectively.

Celiac (or coeliac) disease (CD) is a small bowel disorder that occurs upon exposure to dietary gluten and is thought to be two to three times more common in females than males.

CD impairs digestion and can lead to malabsorption of nutrients resulting in weight loss and/or diarrhea.

It is estimated that a large population of American women (up to 1 in 70) may have undiagnosed CD.

The only treatment for CD is strict and life-long adherence to a gluten-free diet. Further, a gluten-free diet can prevent and correct most complications linked to untreated CD, including during pregnancy.

Gluten Intolerance and Pregnancy

Untreated and undiagnosed CD has been theorized to cause reproductive and pregnancy complications, such as infertility, miscarriage, and preterm delivery, based on its resulting malnutrition and inflammation, although the strength of these associations is debated.

Pregnant women with undiagnosed CD have also been shown to have up to a nine-fold relative risk of recurrent miscarriage compared with women with CD on a gluten-free diet.

Undiagnosed CD or non-adherence to a gluten free diet may cause folic acid, vitamin B12, fat-soluble vitamin, and iron deficiencies, which could potentially be an additional pathway to the above complications.

Undiagnosed celiac disease may have such a strong effect on infertility and miscarriage that some researchers have advocated routine screening for CD in pregnant women – even without risk factors.

The argument for routine CD screening is due to CD being considerably more common than most of the diseases for which pregnant women are already routinely screened. Further, screening tests are sensitive, specific, acceptable, and accessible.

One study documented three patients with untreated CD and infertility, all of whom became pregnant after starting a gluten-free diet [interpret with caution – very small study]. However:

The largest study of fertility in women with CD included 11,000 women of reproductive age with biopsy-proven CD; CD was not associated with decreased fertility once their CD was treated.

Women can also be diagnosed with nonceliac gluten sensitivity (NCGS), in which symptoms are similar, but biopsy results are negative for CD. It is unknown whether NCGS is caused by gluten or other components of wheat.

The prevalence rate of NCGS is also unknown but is suspected to be higher than that of CD. Symptoms may include abdominal bloating and pain, diarrhea, nausea, mouth ulcers, constipation, irritation, depression, and bone and joint pain.

Women who believe they may be affected by gluten or another gastrointestinal disorder should talk to their HCP.

Gluten Free Diet

High-quality evidence is lacking to support a gluten-free diet for any beneficial health effects in women who do not suffer from CD, NCGS, wheat allergies, or irritable bowel syndrome.

In fact, gluten avoidance can have negative effects in those without proven gluten-related diseases.

Many gluten-free foods are not enriched and may be deficient in several nutrients, including dietary fiber, folate, iron, niacin, riboflavin, and thiamine, with higher levels of lipids, trans fat, protein, and salt.

Further, there is a lack of evidence regarding an association between a diet with or without gluten during pregnancy and the risk of celiac disease in children (and those same children into adulthood).

However, at least two animal studies and one human study concluded that a gluten-free diet (only during pregnancy) appeared to lower the risk of type 1 diabetes in the offspring (type 2 is less clear).However, this can be considered preliminary and further research is necessary.

Food Sources

Wheat, barley, rye, malt and possibly oats (due to potential cross contamination) are the largest sources of gluten in the diet. Gluten can also be hidden in anything from restaurant omelets to medicine.

Gluten is also very common in foods such as bread, pasta, noodles, tortillas, and baked goods.

Action

For women with celiac disease, a strict adherence to a gluten-free diet is vital and will help prevent serious problems during pregnancy. HCPs will monitor women with celiac disease, or other malabsorption disorders, for potential nutrient deficiencies. 

Women should speak to their HCP if they suspect, or they are concerned they may have a gluten intolerance or other gastrointestinal disorder as screening tests are readily available.

Any woman who wishes to engage in a gluten-free diet during pregnancy, without a medical reason, is advised to tell her HCP. The HCP will want to further assess the woman's diet, to make sure she is still obtaining optimal nutrition during pregnancy.

Resources

What is Gluten? (Celiac Disease Foundation)

Gluten (BeyondCeliac.org)

What is Gluten-Free? (U.S. Food and Drug Administration)

References

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