Pregnancy is an incredible journey, but for women with coeliac disease it is still an ongoing challenge. Properly managing a nutritionally balanced and strict gluten-free diet during the journey to motherhood continues to be a difficult task. Current guidelines (1) do not provide recommendations for determining the appropriate energy intake for coeliac women during pregnancy.
An international panel, led by the Fondazione IRCCS Ca’ Granda-Milano, Reference Centre for the Prevention and Diagnosis of Coeliac Disease, and Clinica Mangiagalli in Milan, has begun addressing this clinical need, thanks to the support of the Anton Schär Foundation, committed to improving the quality of life of people with special nutritional needs.
The project aims to identify a scientifically validated pathway to ensure proper management of the gluten-free diet during conception, pregnancy and post-partum.
During this delicate phase of life, diet plays a key role, in terms of both meeting a woman’s changing nutritional needs and ensuring proper foetal development. Iron, calcium, folic acid, omega 3 such as DHA, and B vitamins are among the key micronutrients to be monitored (2,3), from pre-conception to breastfeeding, to prevent deficiencies, especially in the case of a therapeutic diet, such as the gluten-free diet for treating coeliac disease.
The gluten-free diet must, in fact, be optimised from the pre-conception stages to ensure proper embryonic development and placentation, reducing inflammation levels that increase the risk of pregnancy-related complications. An international panel of experts is working to provide recommendations based on the GRADE methodology, applying the formal process of using the Evidence to Decision Framework (EtD), with the aim of addressing gaps in the clinical management of pregnant women with coeliac disease.
Directives on which the team is working include:
- Pre-conception counselling: women with coeliac disease who are on a gluten-free diet should receive prenatal counselling to optimise their diet and nutritional status.
- Monitoring and support: regular monitoring of nutritional status during pregnancy and breastfeeding is essential.
- Education: providing educational materials on gluten-free nutrition and meal planning can empower women to make informed food choices during these critical periods.
References:
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SIGE,SIED, AIGO, SIGENP (2023) Linea guida: “Diagnosi, terapia e follow-up della malattia celiaca e della dermatite erpetiforme”
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Devarshi, P., Legette, L., Grant, R., & Mitmesser, S. (2021). Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age. The American Journal of Clinical Nutrition, 113, 1042 - 1052
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Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 2017 Apr;40:55-67. doi: 10.1016/j.bpobgyn.2016.09.007. Epub 2016 Oct 1. PMID: 28029503.
