Tag Archives: celiac disease and pregnancy

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Pregnancy risk factors for the development of celiac disease

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.

Reference:

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.

 

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Celiac Disease “Journal Club” 2013 Part 2

This is going to be a quick post, as I am getting ready to head to Cincinnati for a wedding, and then to Chicago for the International Celiac Disease Symposium 9/22-9/25. I look forward to being able to meet some of you in person at this conference, and to hear the experts, including Dr. Fasano, speak about the most recent research, recommendations, and guidelines regarding the diagnosis and management of both celiac disease and non-celiac gluten sensitivity.

Below are summaries of three recent journal articles that may be of interest. Part 1 of my Celiac “Journal Club” series can be seen here. Under each article summary statement I am including a link to some of my previous posts about relevant topics.

1. “2013 update on celiac disease and eosinophilic esophagitis.” Authors: Pellicano, R, et al. Published in Nutrients in Aug. 2013.

-authors reviewed 30 publications regarding celiac disease and eosinophilic esophagitis (EoE), a chronic inflammatory disorder of the esophagus which is on the rise. They found that the prevalence of EoE in subjects with celiac disease is 10x higher than the general population in the majority of the studies. They recommend that all children who get small intestinal biopsies for celiac disease diagnosis also get evaluated for EoE.

-for more information on the relationship between EoE and Celiac Disease, as well as an overview of the symptoms of EoE, please see my post from Jan. 2013.

2. “The rising incidence of celiac disease in Scotland.”  Authors: White, L, et al. Published in Pediatrics in Sept. 2013.

-researchers looked at the incidence of celiac disease in children in Scotland from 1990 to 2009. Overall incidence increased by 640% over this 20 year period, with the incidence of “atypical” celiac disease increasing by 1140%!

-of note, 51% of the children who were actively screened for celiac disease and found to have celiac disease had no symptoms at all. Active screening takes place if a child is in a “high risk” category for celiac disease, i.e. has a sibling or other first degree relative with celiac disease.

-for more information on the screening of children for celiac disease, and who should be screened, please check out my post from June 2013.

3. “Potential new mechanisms of placental damage in celiac disease: anti-tranglutaminase antibodies impair human endometrial angiogenesis.” Authors: Simone, N., et al. Published in Biol Reprod in Aug. 2013.

-the authors demonstrate that tissue transglutaminase antibodies seen in celiac disease damage the placenta by interfering with the development of crucial placental blood vessels.  This finding helps to explain why women with untreated celiac disease often have problems of infertility, miscarriages, and fetal growth restriction.

-I wrote about the topics of Celiac Disease and Pregnancy in Jan. 2013 (see link) and Celiac Disease and Infertility in Mar. 2013 (see link).

I anticipate returning from Chicago with a lot to write about on this page. I will also be making my conference tweeting debut (@PatientCeliac), so feel free to follow me for real-time updates. Lastly, if you will be attending, please reach out and let me know so that we can meet!