Pregnancy Complications and Adverse Birth Outcomes Among Women With Celiac Disease

A Population-Based Study From England

Alyshah Abdul Sultan PhD; Laila J Tata PhD; Kate M. Fleming PhD; Colin J. Crooks PhD; Jonas F. Ludvigsson PhD; Nafeesa N. Dhalwani PhD; Lu Ban PhD; Joe West PhD

Disclosures

Am J Gastroenterol. 2014;109:1653-1661. 

In This Article

Abstract and Introduction

Abstract

Objectives Evidence-based information about adverse birth outcomes and pregnancy complications is crucial when counseling women with celiac disease (CD); however, limited population-based data on such risks exist. We estimated these for pregnant women with CD diagnosed before and after delivery.

Methods We included all singleton pregnancies between 1997 and 2012 using linked primary care data from the Clinical Practice Research Datalink and secondary care Hospital Episode Statistics data. Risks of pregnancy complications (antepartum and postpartum hemorrhage, pre-eclampsia, and mode of delivery) and adverse birth outcomes (preterm birth, stillbirth, and low birth weight) were compared between pregnancies of women with and without CD using logistic/multinomial regression. Risks were stratified on the basis of whether women were diagnosed or yet undiagnosed before delivery.

Results Of 363,930 pregnancies resulting in a live birth or stillbirth, 892 (0.25%) were among women with CD. Diagnosed CD was not associated with an increased risk of pregnancy complications or adverse birth outcomes compared with women without CD. However, the risk of postpartum hemorrhage and assisted delivery was slightly higher among pregnant women with diagnosed CD (adjusted odds ratio (aOR)=1.34). We found no increased risk of any pregnancy complication among those with undiagnosed CD. We only observed a 1% absolute excess risk of preterm birth and low birth weight among undiagnosed CD mothers corresponding to aOR=1.24 (95% confidence interval (CI)=0.82–1.87) and aOR=1.36 (95% CI=0.83–2.24), respectively.

Conclusions Whether diagnosed or undiagnosed during pregnancy, CD is not associated with a major increased risk of pregnancy complications and adverse birth outcomes. These findings are reassuring to both women and clinicians.

Introduction

Subclinical pathological evidence of celiac disease (CD) is present in around 1% of most European populations,[1] of which approximately 0.2% have been clinically diagnosed with CD.[2] This suggests that about 10 in 1,000 pregnant women could have some form of latent or undetected CD and that about 2 in 1,000 deliveries per year in the United Kingdom will be in women with known CD. Given this estimated prevalence and the potential adverse physiological effects that CD might engender, it is surprising that very few good studies have been produced that have tried to quantify the risks to the mother and the child around delivery. The studies[3–9] that have tried to quantify the risks of pregnancy and delivery-related adverse events among women with CD can be categorized broadly as either case series of individuals, in single or multiple centers pooled together, or registry based. Most case series[4,10,11] have been based on a small number of pregnant women with known CD (i.e., <150) or pregnant women who are screened for positive serology leading to the identification of a small number of women with previously undiagnosed CD. Unsurprisingly, the results are conflicting; e.g., Martinelli et al.[11] reported that the 12 pregnant women that they found to have undiagnosed CD were more likely to have babies with low birth weight compared with those with negative serology. However, a similar study based on 52 undiagnosed cases from multiple centers found no excess risk of low birth in offsprings.[10] Larger studies from Sweden and Denmark[7,8] have used inpatient national registries to identify women with CD, which provide greater number of women but appear to underestimate the prevalence of CD. This may explain their findings of an increased risk of some adverse birth outcomes for both mother (cesarean section) and child (low birth weight, intrauterine growth restriction)[7,8] if the populations they have studied were not generalizable to all women with CD.

It appears therefore that accurate contemporary estimates of the risk of adverse birth outcomes among women with undiagnosed and diagnosed CD that are generalizable to the majority are absent. Therefore, we have carried out a population-based cohort study using primary and secondary health-care data from England with the aim of quantifying the risks of pregnancy complications and adverse birth outcomes among women with CD.

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