Long-term effects of maternal celiac disease on their children

The incidence of celiac disease has increased in recent years, with the highest incidence among women and children. (2)  Various studies have examined the short-term effects of celiac disease and concluded that there is an increased risk of infection in patients with celiac disease. These include community-acquired infections, pneumococcal infections, Clostridium difficile infections, tuberculosis infections and sepsis. (3) The studies also revealed that celiac disease affects the course of pregnancy and can limit intrauterine growth, reduce birth weight, lead to premature birth, miscarriage or birth complications. (4-10)

Only a few studies examine the long-term effects of celiac disease on these mothers’ children. The team, led by Naim Abu-Freha from the Institute of Gastroenterology and Hepatology at Soroka University Medical Center in Israel, addressed these long-term effects. They aimed to investigate the long-term infectious morbidity of offspring whose mothers are affected by celiac disease.

Methods

A population-based cohort study was conducted, in which all single births between the years 1991 and 2014 were included. The offspring were divided into two groups: offspring of mothers with celiac disease and offspring of mothers without celiac disease. Demographic and clinical data were collected for both groups. These included: maternal age, number of births, gestational and pregestational diabetes mellitus, hypertensive disorders of pregnancy (chronic or gestational hypertension and preeclampsia with or without severe features), gestational age, and gender. A Kaplan-Meier survival curve was used to compare the cumulative incidence of hospitalizations during the study period. In addition, the Cox model, a regression method for analyzing survival data, was used to establish an independent association between celiac disease in pregnancy and the future incidence of infection-related hospitalizations in the offspring. 

Results

During the study period, 210 (0.09%) mothers with celiac birthed children, compared to 242,170 (99.91%) mothers without celiac disease who delivered. Mothers with celiac disease had significantly lower rates of hypertensive pregnancy disorders compared to mothers without celiac disease. There were no significant differences in maternal age at birth or gestational age. Premature births (<37 weeks gestation) were more frequently observed in the group of mothers with celiac disease (10.4% vs. 6.9%; p = .04). Newborns born to mothers with celiac disease were more likely to have lower birth weight (<2,500g) 14.2% vs 6.7% (p<.001). Bacteremia and central nervous system infections were significantly more common in the offspring of mothers with celiac disease compared to mothers without celiac disease (p<.001 and p=0.028). Further, the Kaplan-Meier curve, used to plot survival rates, revealed a higher cumulative incidence of infection-related hospitalizations during pregnancy in the children of mothers with celiac disease compared to mothers without celiac disease. Using the Cox regression model, the connection between maternal celiac disease during pregnancy and long-term hospital stays due to the infection was used to confirm that maternal celiac disease poses a significant and independent risk of prolonged hospital stays for infection-related complications.

This research revealed that maternal celiac disease is a risk factor for long-term infectious morbidity in children, particularly bacteremia and central nervous system infections. Future research is warranted to assess differences in outcomes based on diet adherence and disease control.