Gastroenterology

Gastroenterology

Volume 129, Issue 2, August 2005, Pages 454-463
Gastroenterology

Clinical—alimentary tract
Celiac Disease and Risk of Adverse Fetal Outcome: A Population-Based Cohort Study

https://doi.org/10.1053/j.gastro.2005.05.065Get rights and content

Background & Aims: Studies of maternal celiac disease (CD) and fetal outcome are inconsistent, and low statistical power is likely to have contributed to this inconsistency. We investigated the risk of adverse outcomes in women with CD diagnosed prior to pregnancy and in women who did not receive a diagnosis of CD until after the delivery. Methods: A national register-based cohort study restricted to women aged 15–44 years with singleton live born infants was used. We identified 2078 offspring to women who had received a diagnosis of CD (1964–2001): 1149 offspring to women diagnosed prior to birth and 929 offspring to women diagnosed after infant birth. Main outcome measures were: intrauterine growth retardation, low birth weight (<2500 g), very low birth weight (<1500 g), preterm birth (<37 gestational weeks), very preterm birth (<30 gestational weeks), and caesarean section. Results: Undiagnosed CD was associated with an increased risk of intrauterine growth retardation (OR = 1.62; 95% CI: 1.22–2.15), low birth weight (OR = 2.13; 95% CI: 1.66–2.75), very low birth weight (OR = 2.45; 95% CI: 1.35–4.43), preterm birth (OR = 1.71; 95% CI: 1.35–2.17), and caesarean section (OR = 1.82; 95% CI: 1.27–2.60). In contrast, a diagnosis of CD made before the birth was not associated with these adverse fetal outcomes. Conclusions: Undiagnosed maternal CD is a risk factor for unfavorable fetal outcomes, but the risks are reduced when CD has been diagnosed. CD diagnosed prior to pregnancy does not constitute a great a risk as undiagnosed CD.

Section snippets

Definition of Celiac Disease

We defined CD according to the following international classification of disease (ICD) codes: ICD-7: 286.00; ICD-8: 269.00, 269.98; ICD-9: 579A; ICD-10: K90.0. Women with a hospital-based discharge diagnosis of CD between 1964 and 2001 were identified through the Swedish national inpatient register. This individual-based information was obtained from the Swedish National Board of Health and Welfare. The national inpatient register has been described by Askling et al.3 This study was approved by

Background Data

Most women were 20–34 years of age when giving birth (Table 1). Few women reported smoking during pregnancy, and almost all women were of Nordic nationality. Among the 2078 women with CD, 1149 were diagnosed before birth, and 929 were undiagnosed (255 had a hospital discharge diagnosis of CD within less than 5 years after infant birth, and 674 received a hospital discharge diagnosis 5 years or more after infant birth). Only 3.8% of offspring to mothers with undiagnosed CD were born during the

Discussion

This study found that women with CD that was undiagnosed at the time of delivery were more likely to have a preterm birth; caesarean section; or have an offspring with IUGR, LBW, or VLBW. In contrast, maternal CD diagnosed before birth was not associated with adverse fetal outcomes. Our results underline the importance of screening for CD among women of reproductive age because some 1% of young people may have CD,6, 7, 8, 9, 10 and treatment seems to reduce dramatically the rate of

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    Supported by grants from The Örebro Society of Medicine, The Sven Jerring Foundation, Karolinska Institute funds, The Swedish Society of Medicine, the Swedish Research Council, the Majblomman Foundation, and Örebro University Hospital (to J.F.L. [for manuscript preparation]).

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