There are no official guidelines for pregnancy with celiac disease. However, it is important to follow-up with your celiac specialist/GI doctor if you are planning to become pregnant to make sure you have healed and recovered since diagnosis. A recent study found that women with diagnosed celiac disease and on the gluten-free diet did not have any increased risk of adverse outcomes than those without celiac disease. However, those who were not yet diagnosed had an increased risk of miscarriage and stillbirth. (1)

Here are some general recommendations about pregnancy and celiac disease:

• Timing: Plan pregnancy after you have recovered on the GF diet and antibody levels have normalized, villi have healed, and any nutrient deficiency has been resolved (this is usually at least 6-12 months after diagnosis)
• Have your celiac-related antibodies tested
• Test for nutrient deficiencies associated with celiac disease such as: iron, folate, B12, vitamin D, zinc, copper, and magnesium
• Have your thyroid levels checked (2)

If you have not already, inform your OB/GYN now about your celiac disease so that they are aware of it, and can monitor you throughout your pregnancy.

Nutritional Considerations

It is recommended that women of childbearing age get at least 400 mcg of folate per day and 600 mcg during pregnancy to prevent neural tube defects in the baby. The neural tube forms very early in pregnancy, before most women know they are pregnant, making it important to take folate before and early in pregnancy. (3) People with celiac disease are at risk of folate deficiency due to malabsorption in the small intestine. Another compounding issue is that the gluten-free diet is generally low in folate and products are rarely fortified with folate like their gluten-containing counterparts are such as breads and cereals.

The Recommended Dietary Allowances (RDA’s) for folate are:

Women aged 18 and over - 400 mcg

Pregnant - 600 mcg

Breastfeeding - 500 mcg

GF foods rich in folate:

Spinach

Brussels sprouts

Broccoli

Beans/lentils

Peas

Rice

(4)

People with celiac disease are also at risk for iron deficiency and anemia. Iron deficiency anemia can cause complications in pregnancy such as, premature birth, a low birth weight baby and postpartum depression.

GF foods rich in iron:

Meat and poultry

Fish and seafood (choose those low in mercury)

Eggs

Legumes

Nuts and seeds

Dark leafy greens including spinach and chard

(nonheme iron is best absorbed with vitamin C foods)

Another consideration is to get enough calcium and vitamin D needed for bone health.

GF foods rich in calcium:

Dairy (milk, yogurt, cheese)

Dairy alternatives (check label)

Calcium fortified orange juice

Tofu/soybeans (check label)

Broccoli

Leafy greens: collard greens, kale, spinach

Sources of vitamin D:

Sunlight

Fatty fish (choose low mercury)

Fortified dairy products

Fortified milk alternatives (check label)

Finally, your doctor may recommend a prenatal supplement to take before and during pregnancy. Make sure that any supplement or prenatal vitamin that you take is labeled gluten-free. Read more about supplements here.

References:

1. L Grode, B H Bech, O Plana-Ripoll, M Bliddal, I E Agerholm, P Humaidan, C H Ramlau-Hansen, Reproductive life in women with celiac disease; a nationwide, population-based matched cohort study. Human Reproduction. Volume 33, Issue 8, August 2018, Pages 1538–1547, https://doi.org/10.1093/humrep/dey214
2. Academy of Nutrition and Dietetics. Treating Gluten-Related Disorders Course. Gluten-Free diet and the Lifecycle. Published May 15, 2020.
3. Centers for Disease Control and Prevention (CDC). Folic Acid. CDC Website: https://www.cdc.gov/ncbddd/folicacid/about.html Updated April 19, 2021.
4. National Institute of Health, Office of Dietary Supplements. Folate Fact Sheet for Health Professionals. US Department of Health and Human Services Website: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ . Updated March 29, 2021.

Reviewed and updated October 21, 2022.