A woman who does not know she has Celiac disease while she is pregnant is at increased risk of delivering preterm and having an infant with poor growth, Swedish investigators report. Diagnosis and treatment prior to pregnancy reduces that risk.
Celiac disease is a common digestive disease that can cause abdominal pain, Diarrhea, and bloating. The disease stems from an abnormal sensitivity to gluten, a protein found in wheat, barley, and rye products. There is no cure for the disease, but patients can eliminate the symptoms by sticking to a gluten-free diet.
“Our hypothesis (was) that if a women has a celiac disease diagnosis prior to birth she would be treated with a gluten-free diet, then the inflammation in the small (intestine) would diminish within 1 or 2 years,” said lead investigator Dr. Jonas F. Ludvigsson. “Probably these women would not suffer Malabsorption and would have normal pregnancies.”
Celiac disease Definition
Celiac disease is an inherited autoimmune disease that usually affects several organs in the body before diagnosis and treatment. When a person with celiac disease consumes any food, beverage, or medication containing wheat, barley, rye, and possibly oats, their immune system is “triggered” and responds by damaging the lining of the intestinal tract.
As a result, the absorption of nutrients is altered and the risk of developing other autoimmune disorders, infertility, miscarriage, neurological conditions, osteoporosis, and certain types of cancer is increased.
The symptoms of untreated celiac disease can be intestinal in nature (such as constipation, recurrent abdominal pain, bloating, diarrhea, weight loss, lactose intolerance, malnutrition) or seemingly non-intestinal (anemia, fatigue, muscle cramps, bone and joint pain, mouth ulcers, irritability, seizures, depression). Some people have no symptoms whatsoever. Lactose intolerance is common upon diagnosis and typically resolves after treatment.
Blood work screening is usually the first step in making a diagnosis. The diagnosis can be confirmed by conducting an endoscopy (EGD) with biopsy samples. The disease can first develop at any point in life from infancy to late adulthood. The cause for the disease is unknown.
There is no known cure at this time but there is an effective treatment - the gluten-free diet. This diet, when followed stringently, is effective because it eliminates the “triggers,” thereby preventing symptoms and manifestations of the disease.
Ludvigsson, of Orebro University Hospital and his associates, analyzed data from the Swedish National Board of Health and Welfare for roughly 2.8 million births between 1973 and 2001 to women without Celiac disease and for 2078 births to women diagnosed with celiac disease between 1964 and 2001. Of these women, 1149 were diagnosed with celiac disease before giving birth.
Compared with women with no celiac disease, those with undiagnosed celiac disease at birth were 62 percent more likely to have an infant with poor growth in the womb, the researchers report in the medical journal Gastroenterology. Moreover, women with undiagnosed disease were at least twice as likely as unaffected women to have a baby with a low birth weight.
By contrast, a diagnosis of celiac disease before birth was generally not associated with these adverse effects on the developing infant.
“To have a similar (and normal) risk of preterm birth or low birth weight as women without celiac disease, Celiac disease should probably be detected 1 or 2 years before pregnancy,” Ludvigsson added, so the associated small intestine problems can resolve.
Conversely, he advised doctors to consider a diagnosis of celiac disease in women with fatigue and abdominal symptoms who have given birth to infants in the past with growth problems.
SOURCE: Gastroenterology, August 2005.
Revision date: July 3, 2011
Last revised: by Jorge P. Ribeiro, MD