Celiac disease in pregnancy and the risk of birth defects

Celiac disease is common among women of childbearing age, but the impact their condition has on pregnancy and fetal development is unclear. The British Society of Gastroenterology recommends serological testing for celiac disease in patients with chronic diarrhea (1), but celiac disease goes undetected in many women without classic symptoms. (2)

The study by Nathalie Auger et al. examines the link between celiac disease and the risk of birth defects during pregnancy. Births between 1989 and 2016 in Quebec, Canada were examined. The team used diagnostic codes to identify women with celiac disease and infants with different types of birth defects. Researchers also examined whether celiac disease had been diagnosed prior to pregnancy and whether women were hospitalized for celiac disease before or after pregnancy.

The study included 2,184,888 infants, including 125,081 with birth defects and 2,238 whose mothers had celiac disease. Compared to infants born to mothers without celiac disease, children born to women with celiac disease had a 1.58-fold greater risk of heart defects (95% CI 1.12 to 2.22) and a 1.56-fold greater risk of urinary tract defects (95% CI 1.06 to 2.32). Both women with two or more celiac disease-related hospitalizations and women whose celiac disease was not diagnosed until after birth were at greater risk of having infants who later went on to develop a heart defect (risk ratio (RR) 3.06, 95% CI 1.81 to 5.15 and RR 1.94, 95% CI 1.31 to 2.88, respectively) . The link between celiac disease and heart defects was stronger before the year 2000. A connection with other developed defects was not found.

Despite the increasing incidence of celiac disease among women, few studies have looked at the link between celiac disease and birth defects. (3) The present study was able to substantiate a relationship between celiac disease and cardiac and urinary defects. Researchers found that heart defects were more common when celiac disease was diagnosed after birth. This finding is consistent with a Swedish study of 52,304 infants that also linked heart defects to celiac disease, particularly in women whose celiac disease was diagnosed after pregnancy. (4) Undetected celiac disease can lead to malabsorption, mucosal inflammation, and circulating pro-inflammatory cytokines— all of which are factors that can contribute to birth defects. The notably weaker association between birth defects and celiac disease among women who receive a diagnosis prior to pregnancy suggests that a gluten-free diet may help reduce the risk of complications during fetal development.

The results of the study suggest that celiac disease, particularly undetected or untreated celiac disease, is associated with an increased risk of birth defects such as heart disease and urinary tract complications. Women with celiac disease could benefit from prenatal counseling and dietary changes to help implement a gluten-free diet to prevent birth defects.