Celiac Disease

CD: Pregnancy Outcomes (2006)

• Intervention
  What is the long-term effectiveness in women with undiagnosed or untreated celiac disease following a gluten-free dietary pattern on pregnancy outcomes?

  • Conclusion
    Several cohort and case-control studies have reported that women with undiagnosed or untreated celiac disease have an increased risk of spontaneous abortion and miscarriage, low birth weight and small for gestational age newborns, stillbirth, perinatal disease and mortality, low Apgar scores, delayed menarche and early menopause, premature delivery, intrauterine growth retardation, breech presentation and Cesarean delivery, while compliance with a gluten-free dietary pattern results in risks similar to those of healthy controls. Despite the increased risks of complications, the overall number of pregnancies does not appear to be influenced by celiac disease. Evidence is limited in the areas of fertility, breast-feeding duration, threatened abortion, secondary amenorrhea, and labor induction; further research is needed in these areas.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the long-term effectiveness of following a gluten-free dietary pattern on pregnancy outcomes
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ciacci C, Cirillo M, Auriemma G, Di Dato G, Sabbatini F, Mazzacca G.  Celiac disease and pregnancy outcome.  Am J Gastroenterol 1996; 91(4): 718-722.
      • Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G.  Grown-up celiac children:  the effects of only a few years on a gluten-free diet in childhood.  Aliment Pharmacol Ther 2005; 21(4): 421-429.
      • Greco L, Veneziano A, Di Donato L, Zampella C, Pecoraro M, Paladini D, Paparo F, Vollaro A, Martinelli P.  Undiagnosed coeliac disease does not appear to be associated with unfavorable outcome of pregnancy.  Gut 2004; 53:149-151. 
      • Kotze LMS.  Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease.  J Clin Gastroenterol 2004;38(7):567-574.
      • Ludvigsson JF, Montgomery SM, Ekbom A.  Celiac disease and risk of adverse fetal outcome:  a population-based cohort study.  Gastroenterology 2005; 129(2):454-463. 
      • Martinelli P, Troncone R, Paparo F, Torre P, Trapanese E, Fasano C, Lamberti A, Budillon G, Nardone G, Greco L.  Coeliac disease and unfavourable outcome of pregnancy.  Gut 2000; 46: 332-335. 
      • Norgard B, Fonager K, Sorensen HT, Olsen J.  Birth outcomes of women with celiac disease:  a nationwide historical cohort study.  Am J Gastroenterol 1999;94(9):2435-2440. 
      • Sheiner E, Peleg R, Levy A.  Pregnancy outcome of patients with known celiac disease.  Eur J Obstet Gynecol Reprod Biol 2005; Nov 22, Epub.
      • Sher KS, Mayberry JF.  Female fertility, obstetric and gynaecological history in celiac disease:  a case control study.  Acta Paediatr Suppl 1996; 412: 76-77. 
      • Smecuol E, Maurino E, Vazquez H, Pedreira S, Niveloni S, Mazure R, Boerr L, Bai JC.  Gynaecological and obstetric disorders in celiac disease:  frequent clinical onset during pregnancy or the puerperium.  Eur J Gastroenterol Hepatol 1996; 8(1): 63-89.
      • Tata LJ, Card TR, Logan RFA, Hubbard RB, Smith CJP, West J.  Fertility and pregnancy-related events in women with celiac disease:  a population-based cohort study.  Gastroenterology 2005; 128(4):849-855. 
  • Search Plan and Results: CD: Pregnancy Outcomes 2007