Issn Print: 0029-7828

Publication Date: 1996/11/01


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Celiac Disease and Pregnancy Outcome

Carolina Ciacci; Massimo Cirillo; Gennaro Auriemma; Giorgio Di Dato; Francesco Sabbatini; Gabriele Mazzacca

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Excerpt

Celiac disease (CD) may cause a syndrome ranging from overt malabsorption to subclinical disorders. It has been suggested that CD also affects the outcome of pregnancy, but the evidence is still circumstantial. This study deals with selected indices of pregnancy outcome in untreated and treated CD women, using different types of comparisons. First, a case-control design was used to compare pregnancy outcome in untreated and treated CD women (analysis A). This group consisted of 94 women with untreated CD and 31 women with at least 1 year of regular treatment with a gluten-free diet. Second, untreated women (N=94) with CD were analyzed to determine whether the outcome of pregnancy relates to the severity of the disease (analysis B). Finally, the intraindividual effect of gluten-free diet in outcome of pregnancy was analyzed in treated and untreated CD women (analysis C). This analysis was composed of 12 CD women, not included in the other analyses, who had at least one pregnancy either when symptoms leading to diagnostic work-up for CD were already present or after at least 1 year of regular treatment with a gluten-free diet. The study deals with data collected in the subgroup of women (N=137) who reported at least one pregnancy after development of CD.
In analysis A, age at diagnosis was significantly lower among treated women (22.4 plus/minus 1.6 years) than among untreated women (37.3 plus/minus 1.2 years). The individual abortion:pregnancy rate was, on average, six times higher in untreated than in treated women. The prevalence of abortion in pregnancies was 17.8 percent among untreated CD women and 2.4 percent among treated CD women. The low birth weight baby:pregnancy ratio was higher and duration of breast-feeding shorter in untreated than in treated patients. The prevalence of low birth weight babies was 12.7 percent among untreated CD women and 2.4 percent among treated CD women.
In analysis B, among women in the untreated group, 31 (33 percent) did not have diarrhea and 23 (24.5 percent) did not have anemia at the time of diagnosis. The abortion: pregnancy ratio and the premature delivery:pregnancy ratio were lower in CD women without diarrhea than in those with diarrhea. In contrast, CD women without diarrhea had a greater ratio of low birth weight baby:pregnancy and lower duration of breast-feeding than those with diarrhea. None of these differences was statistically significant. Body mass index was similar in CD women with and without anemia. The abortion:pregnancy ratio and the premature delivery:pregnancy ratio were higher in CD women without anemia than in those who were anemic. Duration of breast-feeding was lower in those without anemia than in those with anemia. None of these differences was statistically significant.
In analysis C, among CD women who had at least one pregnancy when treatment had not yet been initiated and after 1 year or more of regular treatment with a gluten-free diet, the abortion:pregnancy ratio was lowered more than five times by treatment with a gluten-free diet. The prevalence of abortion in pregnancies was 43.3 percent during the untreated period and 7.7 percent during the treated period. The relative risk of abortion was 9.18 times greater in untreated than in treated conditions. No low birth weight babies were born to patients on a gluten-free diet, whereas the prevalence of low birth weight babies was 29.4 percent during the untreated period. The premature delivery:pregnancy ratio was reduced, but not significantly. Duration of breast-feeding was more than twice as long when CD women were on treatment, but the difference was not statistically significant.
(Celiac disease (CD) is a gastrointestinal malabsorption disorder of childhood and early adult life.

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