"It is premature at this point to talk about screening all pregnant women for CD, especially since the associations in our data were not strong and CD was associated with only a few types of birth defects," Dr. Nathalie Auger of the University of Montreal, Quebec, told Reuters Health by email."
"Testing can be considered for women with gastrointestinal symptoms," she said. "Ideally, women with a positive antibody test for CD should start a gluten-free diet before the 12th week of pregnancy to be effective. This is because most birth defects form between four and 12 weeks of pregnancy."
Dr. Auger and colleagues analyzed discharge summaries for more than two million infants born between 1989 and 2016 in Quebec to determine whether CD was present during prenatal follow-up, or if women required hospitalization for CD before or after pregnancy.
As reported in Gut, 125,081 infants were born with birth defects, of whom 2,238 had mothers with CD. CD, compared with no CD, was associated with 1.58 times the risk of heart defects and 1.56 times the risk of urinary defects.
The risk of heart defects was greater for women with two or more CD-related hospitalizations (risk ratio, 3.06) and for CD diagnosed after delivery (RR, 1.94). The association with heart defects was also stronger before the year 2000 (RR, 2.29), when severe CD with classic presentation was more frequent, according to the authors.
There was no association with other types of defects.
"Women with CD may benefit from prenatal counselling and dietary modification to prevent birth defects," the authors suggest.
Dr. Salvatore Alesci, Chief Scientist and Strategy Officer at Beyond Celiac, a research and advocacy organization in Ambler, Pennsylvania, commented by email, "The current study adds some credible evidence to a handful of previously published studies on the increased risk of birth defects in women with celiac disease."
"To my knowledge, this is the first study to report urinary tract birth defects, and the rationale/scientific basis for that association is...difficult to understand. A reduction of urinary tract defects with the use of multivitamins has been reported, as cited by the authors (https://bit.ly/3hUqK1A), but the evidence is limited and not fully convincing."
"The most important limitations are the lack of information on dietary habits and supplements, which is very important, and also the lack of information on the father of affected children, not just in terms of CD, but also other diseases, particularly genetic and other familiar conditions," he said. "In addition, it would have been good to take into account other comorbidities in the analysis, for example thyroid diseases, and also understand what medications (if any) the mothers may have been taking during pregnancy."
"The take-home message is to be more aware of CD and understand that this is a serious chronic debilitating disease with serious long-term consequences, which often goes undiagnosed or misdiagnosed," he added.
"Independent of their specialty area, clinicians should be more 'on the lookout' for this disease, understanding that GI symptoms may not be the first manifestations," he said. "And, more specifically in light of this study, clinicians should be particularly vigilant in considering the possibility of CD in women of reproductive age."
By Marilynn Larkin
SOURCE: https://bit.ly/3jBImzV Gut, online August 19, 2020.
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