Coeliac disease living in pregnancy

Overview

Coeliac disease is a condition where your immune system reacts to gluten, a protein found in wheat, barley, and rye. For women who are pregnant or planning pregnancy, managing coeliac disease is important for both your health and your baby’s development. With a strict gluten-free diet, most women can have a healthy pregnancy.

About 1 in 100 people have coeliac disease, but many are not diagnosed. It can be first noticed during pregnancy because of symptoms or routine blood tests.

Coeliac disease can affect anyone, but it is more common in people with a family history of the condition or other autoimmune diseases such as type 1 diabetes. It can be diagnosed at any age, including during pregnancy.

Symptoms

Common symptoms

• Diarrhoea or loose stools
• Bloating and gas
• Tiredness (fatigue)
• Stomach pain
• Nausea or vomiting
• Weight loss or difficulty gaining weight during pregnancy

Symptoms in children

• This section focuses on pregnancy, but children with coeliac disease may have poor growth, delayed puberty, or irritability.

Symptoms in older adults

• Older adults may experience iron deficiency anaemia, bone pain, or skin rashes.

Causes

Main causes

• Coeliac disease is caused by an abnormal immune response to gluten in people who have certain genes.
• Eating gluten triggers the immune system to attack the lining of the small intestine, leading to damage and poor nutrient absorption.

Risk factors

• Having a close family member (parent, sibling, child) with coeliac disease
• Having another autoimmune condition, such as type 1 diabetes or thyroid disease
• Certain genetic markers (HLA-DQ2 or HLA-DQ8)

When to see a doctor

See a doctor urgently if:

• If you are pregnant and have severe abdominal pain, heavy bleeding, or signs of dehydration, seek medical help immediately.
• If you accidentally eat gluten and develop severe symptoms that worry you, contact your midwife or doctor.

Book a routine appointment if:

• If you have coeliac disease and are planning a pregnancy, talk to your doctor or dietitian beforehand.
• If you have symptoms that might be coeliac disease (such as ongoing diarrhoea, bloating, or tiredness) during pregnancy, ask for a blood test.
• All pregnant women with coeliac disease should have regular check-ups to monitor nutrition and baby’s growth.

Diagnosis

Coeliac disease is diagnosed with a blood test that looks for certain antibodies. If the test is positive, a small sample (biopsy) of the small intestine is usually taken to confirm the damage. During pregnancy, your doctor will discuss the best timing for tests.

Tests that may be done

• Blood test for tissue transglutaminase antibodies (tTG-IgA)
• Upper endoscopy with biopsy of the small intestine (may be deferred until after pregnancy if possible)

What to expect at your appointment

Your doctor will explain the process. For blood tests, you need to be eating gluten (at least one slice of bread a day for 6 weeks) for accurate results. If you are already on a gluten-free diet, the tests may not be reliable. Your healthcare team will guide you on what is safe during pregnancy.

Treatment

The only treatment for coeliac disease is a lifelong, strict gluten-free diet. This allows the intestine to heal and prevents complications. During pregnancy, a well-planned gluten-free diet is especially important to provide enough nutrients for you and your baby.

Self-care at home

• Remove all foods containing wheat, barley, and rye from your diet.
• Read food labels carefully – gluten can hide in sauces, soups, and processed foods.
• Choose naturally gluten-free foods like fruits, vegetables, meat, fish, eggs, dairy, rice, and potatoes.
• Avoid cross-contamination: use separate toasters, utensils, and chopping boards for gluten-free foods.
• Work with a registered dietitian who specialises in coeliac disease to plan pregnancy-friendly meals.

Medical treatments

No medication can treat coeliac disease. You may need vitamin and mineral supplements if blood tests show deficiencies (for example, iron, folic acid, vitamin D, or calcium). These should be prescribed by your doctor based on your blood test results. Do not take any supplements without medical advice.

When is surgery considered?

Surgery is not used to treat coeliac disease.

Living with this condition

Living with coeliac disease during pregnancy means being extra careful about what you eat. Plan your meals, carry gluten-free snacks, and tell your friends and family so they can support you. Many restaurants now offer gluten-free options – always ask about preparation to avoid cross-contamination.

Lifestyle tips

• Keep a food diary to track your gluten-free intake and any symptoms.
• Join a support group (online or in person) to share tips and encouragement.
• Tell your healthcare team about your coeliac disease so they can check your nutrition and your baby’s growth regularly.

Diet and exercise

Eat a balanced gluten-free diet rich in iron (leafy greens, red meat, legumes), calcium (dairy, fortified alternatives), folic acid (gluten-free grains, vegetables), and fibre (fruits, vegetables, gluten-free oats). Gentle exercise like walking or swimming is safe and beneficial, but listen to your body and avoid overexertion.

Mental health and emotional wellbeing

Managing a strict diet during pregnancy can sometimes feel stressful or isolating. You may worry about accidental gluten exposure harming your baby. It’s normal to feel anxious – talk to your doctor, midwife, or a counsellor. Remember that most accidental exposures are not harmful to the baby, and you can cope with your care team’s help.

Prevention

Coeliac disease itself cannot be prevented. However, the complications of coeliac disease during pregnancy can be greatly reduced by following a strict gluten-free diet and getting regular prenatal care. There is no evidence that a gluten-free diet during pregnancy can prevent coeliac disease in your baby.

Vaccines

Not applicable.

Screening programmes

Screening (blood tests) is recommended for people with a family history of coeliac disease or related autoimmune conditions. If you are pregnant and have symptoms, ask your doctor about testing. Routine screening for all pregnant women is not currently recommended.

Complications

If left untreated

• Increased risk of miscarriage or stillbirth
• Preterm birth (baby born too early)
• Low birth weight
• Nutritional deficiencies (iron, folate, vitamin B12, calcium) that can affect baby’s development
• Fertility problems before pregnancy

Long-term outlook

The outlook for women with coeliac disease is excellent when the condition is well managed. By sticking to a gluten-free diet and working closely with your healthcare team, you can have a healthy pregnancy and a healthy baby. Most women with coeliac disease go on to have normal, uncomplicated pregnancies.

Find support

International organisations

• Coeliac Disease Foundation
• Beyond Celiac

Local organisations

• Coeliac UK · United Kingdom

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