Tag Archives: prevention of celiac disease

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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.

 

The Prevent Celiac Disease Study

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I recently wrote about the best available recommendations for when to introduce gluten to babies who may be at risk of developing Celiac Disease. Although most babies are exposed to small amounts of gluten in breast milk, for my 4th baby (first born after my diagnosis), my breast milk was gluten free. Based on the best available evidence in the medical literature, small amounts of gluten should be given between 4 to 6 months of age, as it seems this is a critical window for the development of the immune system. If gluten is introduced later than this, the consensus is that it is important for breastfeeding to still be taking place during gluten introduction (see references in my previous post for more info).

I understand that this is a controversial area, as many parents feel that they should never introduce gluten to the at-risk child. I believe that, despite our best efforts to shield our children from gluten, they are eventually going to be exposed one way or another.

I did recently discover that the question of the timing of gluten introduction is being explored in Europe right now through the PreventCD study (www.preventCD.com).

This study has been sponsored by the European Union and involves 11 countries. More than 1000 infants were enrolled in the study from 2007 through 2011, and they are now being followed for the development of Celiac Disease from infancy until age 3. Based on the latest newsletter on the study website, the last participant will turn 3 in 2013, and the results will be “unblinded” at this point.

The 1000 infants in the study were all considered to be “at risk” for CD by having a first-degree relative (parent and/sibling) with Celiac Disease and being HLA-DQ2 and/or DQ8 positive. The study “intervention” started at 4 months of age and went for 8 weeks. Half of the babies were given a gluten-containing baby food on a daily basis and half were given a placebo. Breastfeeding was encouraged for both groups during the 8 week period.

The endpoint of the study is to see if there is any difference in frequency of Celiac Disease between the two groups at age 3. As a mom, Celiac, and pediatrician, I am eagerly awaiting these results. I am also intereseted to see if they will have the funding and resources to be able to follow the children into later childhood and adolescence. Either way, the results which they share will be valuable for all of us!

Although the study results will not be published for a while, the researchers have published an interesting review paper on infant feeding and Celiac Disease:

Systematic review: early infant feeding and the prevention of coeliac disease. Szajewska H, Chmielewska A, Pieścik-Lech M, Ivarsson A, Kolacek S, Koletzko S, Mearin ML, Shamir R, Auricchio R, Troncone R; PREVENTCD Study Group.Aliment Pharmacol Ther. 2012 Oct;36(7):607-18.

The full details of their study are described in this paper:

The PreventCD Study design: towards new strategies for the prevention of coeliac disease. Hogen Esch CE, Rosén A, Auricchio R, Romanos J, Chmielewska A, Putter H, Ivarsson A, Szajewska H, Koning F, Wijmenga C, Troncone R, Mearin ML; PreventCD Study Group.Eur J Gastroenterol Hepatol. 2010 Dec;22(12):1424-30.