Studies suggest that undiagnosed maternal coeliac disease has a negative effect on intrauterine growth and birth weight and is associated with increased pre-term birth and caesarean section (NICE, 2009), as well as increased risk of miscarriage. However, compliance with the gluten-free diet reduces these risks to that of the general population.
Patients with coeliac disease should be reviewed when planning a pregnancy (PCSG, 2006) to ensure compliance with the gluten-free diet and nutritional adequacy of the diet. There are no specific guidelines for pregnant women with coeliac disease and they should follow the same advice as the general population (see INDI’s ‘Healthy Eating for Pregnancy’ factsheet for more information). Evidence suggests that gluten-free foods may be lower in thaimin, riboflavin, niacin, iron and folate. As requirements for these nutrients increase during pregnancy it is essential to ensure adequate intake.
Infant Feeding and Weaning
Breast-feeding appears to have a protective effect against the development of coeliac disease (ESPGHAN, 2009). However, this protection may not be permanent and may only delay the onset of symptoms. The World Health Organisation (WHO) recommends breast-feeding exclusively for six months. Irish rates of breast-feeding are poor, with only 47% of Irish mothers initiating breast-feeding; this was further reduced to only 24% offering any breast milk to their infants at six weeks (Tarrant & Kearney, 2008). Breast-feeding should be encouraged in infants at risk of developing coeliac disease. For those who do not breast-feed all first milks used as breast-milk substitutes are gluten-free.
The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN, 2008) recommend introduction of small amounts of gluten-containing foods gradually into the infant’s diet between the ages of 4-7 months while continuing to breast-feed as this appears to reduce the risk of developing coeliac disease. Both early (<3 months) and late (>7 months) introduction of gluten to the diet appear to increase the risk of developing coeliac disease. ESPGHAN (2008) made no recommendations for weaning of formula fed infants at risk of coeliac disease and so introduction of gluten should be delayed until 6 months, in line with previous recommendations.