Many women wonder about issues regarding celiac and pregnancy. When it came to trying to get pregnant, Brynne Cramer had some worries. “Because I have celiac disease, I was initially very concerned about my ability to conceive and carry a healthy baby to full-term,” says Cramer, who runs the blog Gluten-Free Hungry Gal.

Symptoms of undiagnosed celiac disease include infertility and recurrent miscarriage. Cramer was diagnosed four years prior to trying to conceive. But she was still anxious over the impact celiac might have on her fertility and a pregnancy. “I was very nervous,” she explains. “It’s part of the reason we decided to start trying for a baby at a younger age [26].”

Given infertility and miscarriage are symptoms of undiagnosed celiac disease, it’s logical to question whether they could extend into diagnosed celiac. Would these issues continue once diagnosed and adhering to a gluten-free diet? Expanding upon that initial thought, a larger question arises about whether diagnosed celiac fits into pregnancy: Do celiac disease and the gluten-free diet affect pregnancy?

Undiagnosed vs. diagnosed

The risks associated with pregnancy are different before after a celiac diagnosis. “Most of the issues that have been described regarding pregnancy outcomes in celiac disease have been found in undiagnosed celiac disease,” explains Benjamin Lebwohl, M.D., M.S., director of clinical research at The Celiac Disease Center at Columbia University, by email. “That is to say, patients with undiagnosed [and therefore untreated] celiac disease appear to have an increased risk of outcomes such as miscarriages or difficulty conceiving.”

As Lebwohl notes, “The cause of infertility and pregnancy complications in people with undiagnosed celiac disease is not certain, but there are a number of explanations.” Current knowledge centers around how celiac affects the body. “Chronic inflammation and/our malnourishment in the mother may be poorly conducive to successful pregnancy. In addition, laboratory studies have shown that the antibody in celiac disease [tissue transglutaminase] may bind to placenta cells and cause harm”

Following diagnosis, the risk changes. “In those with diagnosed celiac disease who have already started the gluten-free diet, the risk largely goes away,” Lebwohl says. The good news, he explains, is that once diagnosed, “much of the worrisome information out there about fertility and birth outcomes is thankfully no longer relevant.”

Even with such a marked reduction in risk, could length of time from diagnosis factor into conception or pregnancy? For example, will a pregnant woman who was diagnosed a number of years ago and has already done a great deal of gut healing on the gluten-free diet have fewer complications than a pregnant woman who was only recently diagnosed and whose gut is still healing?

“A few years ago, we [The Celiac Disease Center at Columbia University] published an analysis of Swedish patients, comparing women whose intestines had healed to those who had persistent intestinal damage [possibly due to occasional gluten exposure], and found no differences in birth outcomes,” explains Lebwohl. “In both groups, the rates of miscarriage or premature birth were quite low, actually. This underscores the idea that the main time of increased risk is before a celiac disease diagnosis.”

The key to a pregnancy with celiac—and is the key to the disease in general—is adherence to the gluten-free diet and consistent follow-up care. “It is important to stick to a strict gluten-free diet prior to and during pregnancy, and to be up to date with routine celiac antibody and nutrient checks,” advises Lebwohl.

The gluten-free diet and pregnancy

Depending on factors such as ingredients and the absence or presence of nutrients, gluten-free products can be less nutritious than their gluten equivalents. This raises the question of whether a woman with diagnosed celiac needs to approach her prenatal care differently because she is on a gluten-free diet.

“Though the gluten-free diet can sometimes be a vitamin-deficient diet, and folic acid is a particular concern with regard to the developing fetus, the recommendation is the same for celiac patients as non-celiac patients: take a daily prenatal multivitamin,” says Lebwohl.

Folic acid, found in fortified foods such as cereal and in vegetables such as leafy dark greens, is crucial in general, and especially during pregnancy. As the Centers for Disease Control and Prevention (CDC) states on its website, “Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid.” When it comes to pregnancy, the CDC explains, “Folic acid is very important because it can help prevent some major birth defects of the baby’s brain and spine (anencephaly and spina bifida).”

The nutritional focus during pregnancy is the same regardless of whether one needs to eat gluten free. “All women need to be conscious of their nutrition when they are pregnant,” explains Amy Jones, M.S., R.D., L.D. “Ideally, getting your nutrition in order before you get pregnant is best.” For someone with celiac, this would mean “being well controlled on the gluten-free diet” as this “can go a long way in helping to ensure a healthy pregnancy.” Should a woman have any nutritional deficiencies, Jones says to “work with your physician and dietitian to get those corrected, ideally, before you conceive.”

Regardless of celiac, pregnant women often experience constipation in their second or third trimester. For alleviating constipation, Jones points out that “the higher fiber of whole grains may be beneficial.” When eating gluten-free whole grains, Jones says, “be sure to drink enough fluid when you are consuming high-fiber foods.” The benefits of gluten-free whole grains extend beyond fiber. “For example, teff has a lot of calcium, and quinoa has a lot of iron and protein,” Jones notes.

The calcium found in teff and dairy products is an important nutrient during pregnancy. Jones mentions that “for pregnant women who have celiac disease who may be lactose intolerant, it’s important to find a good source of calcium and vitamin D.” For those who can tolerate some lactose, she points to yogurt and cheese, which are both low in lactose. “Supplementation of calcium and vitamin D may be necessary as well,” she says.

Welcome news

Cramer learned firsthand that her diagnosed celiac did not prevent her from getting pregnant or carrying a baby to term. “To my surprise, we got pregnant very quickly,” says Cramer. “I was anxious at every appointment,
but things kept checking out wonderfully.”

Throughout her pregnancy, Cramer found herself feeling like “a typical pregnant woman.” This included enjoying random indulgences—buffalo sauce and chocolate milk. She recommends that pregnant women with celiac “find what gluten-free foods hit the spot and indulge every once in a while. We give up so much already as celiacs—depriving yourself during pregnancy seems silly.”

Cramer and her husband welcomed a beautiful and healthy baby girl last summer.

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.

Photos: SYDA Productions / Shutterstock; Africa Studio / Shutterstock