I had never heard of Doximity, a social networking website for physicians, until a few months ago when I received an email that one of my old medical school classmates had added me as a “colleague” on the site. I discovered that, despite having never signed up for the site, that my profile already existed, which included semi-correct information and a very unflattering photo of me from when I was about 8 months pregnant with my 3rd child (all information that can be easily found on the internet, scarily enough).
I claimed my account, corrected my info, uploaded a new profile photo, and pretty much forgot about the website until last week. When I logged on I searched the physician education/CME page using the words “celiac disease” and there were links to 941 relevant articles. For a research geek like me this was heavenly…and overwhelming!
In one of the most interesting articles that I came across, called “Current evidence on whether perinatal risk factors influence celiac disease is circumstantial,” researchers from Sweden and Norway reviewed the scientific literature on whether or not perinatal factors (from pregnancy up until 7 days after birth) can influence the development of celiac disease. I am interested in this topic because there’s been quite a bit published as to whether celiac disease can be prevented during infancy and childhood and I’ve had many women ask me if there’s anything that can be done during pregnancy to help prevent celiac disease.
The article can be summarized as follows:
Previous research has shown a possible link between being born during the summer months and the later development of celiac disease–thought to possibly be due to pregnant women being exposed to an unknown infection during the winter months and/or having low vitamin D levels due to lack of sunlight. When the authors of this study analyzed all of the research on birth season, however, it appears that season of birth is probably not associated with later celiac disease development.
Although there have not been any studies examining mothers’ vitamin D levels during pregnancy and celiac disease in babies, there is previous evidence that low vitamin D can be associated with atopic (allergic) diseases and Type 1 diabetes in children. My editorial: This is a good reminder that those of us of childbearing age should make sure to adequate vitamin D levels before, during, and after pregnancy, and that we should make sure that our breastfed babies receive their prescribed vitamin D drops (I am guilty of forgetting to do this with my own babies). These authors did find a link between maternal iron supplementation during pregnancy and celiac disease in one of their previous studies, but as far as I can tell this is the only study showing a possible link, so more information is needed.
There is no research showing a link between maternal infections during pregnancy, antibiotics during pregnancy, and infections in the immediate newborn period and the later development of celiac disease in children.
Research results about the effect of mode of delivery (vaginal vs. c-section) and the development of celiac disease in offspring are conflicting. There appears to be a trend toward an increased risk of celiac disease in babies born by elective c-section vs. emergent c-section or vaginally. The authors postulate that infants in the latter two categories are colonized by their mothers’ bacteria in the birth canal (as in most cases of emergency c-sections labor has started) as opposed to those who are born by elective c-section with intact membranes and no bacterial transfer/colonization from mother to baby. I am curious to see if future research supports this association.
Although previous studies showed a link between infants being born small for gestational age and celiac disease, later studies have not supported this relationship. Likewise, celiac disease has not been associated with any of the following pregnancy complications: prematurity, smoking during pregnancy, pre-eclampsia, maternal age, low Apgar scores, stress levels during pregnancy, and blood-type incompatibility between baby and mother.
The bottom line is that although many of us with celiac disease and/or a family history of celiac disease would love to be able to “do something” to prevent our babies from developing celiac disease, right now there is not enough information to guide us. Although I do recommend not smoking during pregnancy, for a multitude of reasons!!!
Thanks for reading, and thanks to all who have warmly welcomed us to the greater Boston area. We are slowly settling into our new life, and I have been eating VERY well, which I will hope to discuss in a future post.
Karl Mårild MD PhD, Jonas F Ludvigsson MD PhD, and Ketil Størdal MD PhD. Current evidence on whether perinatal risk factors influence celiac disease is circumstantial. Acta Paediatrica. Manuscript published online 8/10/2015.