Undiagnosed Celiac Disease Tied to Poor Fetal Outcomes


Maternal celiac disease, undiagnosed at the time of delivery, is a risk factor for adverse fetal outcomes, but celiac disease diagnosed before giving birth is not associated with such outcomes, results from a large Swedish population study suggest.

“Our results underline the importance of screening for CD [celiac disease] among women of reproductive age because some 1% of young people may have CD, and treatment seems to reduce dramatically the rate of complications in pregnancy,” reported the investigators, led by Jonas F. Ludvigsson, M.D., of the pediatric department at örebro University Hospital, Sweden.

Celiac disease is a chronic intestinal malabsorption disorder caused by intolerance to gluten. Diagnosis is suspected on the basis of symptoms, enhanced by laboratory and x-ray studies, confirmed by biopsy, and improved by going on a gluten-free diet, which is the only treatment for this disorder.

Using a national medical registry, Ludvigsson and his associates identified 2,078 women aged 15–44 with a diagnosis of CD who delivered singleton live-born infants from 1973 to 2001. A total of 1,149 women were diagnosed with CD before giving birth, and 929 were diagnosed after giving birth (Gastroenterology 2005;129:454–63).

After adjusting for potential confounding factors such as smoking, age, parity, and diabetes mellitus, the subjects diagnosed with CD after the birth of their offspring were associated with an increased risk of intrauterine growth retardation (odds ratio of 1.62), preterm birth (OR 1.71), cesarean section (OR 1.82), low birth weight (OR 2.13), and very low birth weight (OR 2.45). Subjects diagnosed with CD before the birth of their offspring were not significantly associated with an increased risk of these outcomes.

The investigators reported that the risk for nearly all adverse outcomes was highest among women who received a diagnosis of CD during the 5 years after giving birth.

They postulated that insufficient fetal nutrition causes the increased risk of intrauterine growth retardation and low birth weight seen in offspring of women diagnosed after giving birth.

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