Pregnancy and newborns

Coeliac Disease and Pregnancy

Pregnancy holds no greater risk for women diagnosed with coeliac disease than those without, but it remains important to stick to a strict gluten free diet to avoid pregnancy complications. There are no specific nutritional guidelines for pregnant women with coeliac disease the same advice is given to both women with coeliac disease and women without. You should also aim to follow general healthy eating practices, including plenty of calcium and iron rich foods.

All pregnant women should take a folic acid supplement (400ug a day) prior to conception and until the 12th week of pregnancy to protect against neural tube defects. Eating plenty of green leafy vegetables will also increase your natural intake of folate (folic acid).

It is recommended that certain foods are avoided during pregnancy, these include:

• Foods that may contain listeria – pâté, mould-ripened soft cheese, such as brie, camembert, chevre and others with a similar rind, whether they are made using pasteurised or unpasteurised milk. You should also avoid soft blue-veined cheeses such as roquefort and gorgonzola. Listeria is a type of bacteria that can harm your unborn baby. Although infection with listeria is rare, it is important to take special precautions in pregnancy.

• Raw or partially cooked eggs

• Raw or undercooked meat

• Liver and liver products such as pâté as they may contain a lot of vitamin A. Too much vitamin A can harm your baby.

• Supplements that contain Vitamin A

• Raw shellfish

Weaning your baby

As a coeliac, your baby will have a 1 in 10 chance of developing coeliac disease, but that means there is an overwhelming 9 in 10 chance that they will not get it. You should not introduce gluten into the baby’s diet before six months of age but research suggests there is no benefit in withholding gluten containing foods beyond this point, regardless of family history. It is actually necessary to introduce gluten in to a baby’s diet in order to diagnose coeliac disease. Breastfeeding can help protect against coeliac disease and therefore delay the onset. Formula milk is gluten free if you decide not to breastfeed.

When to wean:

Current guidelines recommend that solid foods be introduced a six months of age, however, it is not uncommon for babies fed solely on milk to require solid food before this age. Solid foods should not be introduced before 4 months of age. If you are unsure if your baby is ready to wean, seek advice from your health visitor or a dietitian.

How to wean:

Babies require energy dense foods in order to fuel growth and development. Suitable gluten free first foods include, pureed fruit and vegetables, and gluten free cereals such as baby rice. Protein containing foods including meat, fish, eggs, beans and pulses may be introduced from around 6 months, in addition to soft finger foods which will help encourage independent eating, co-ordination and chewing skills. Weaning is a gradual process but by one year old, most children will be eating chopped/mashed family foods.

Homemade baby foods are ideal as they allow babies to become used to the tastes and textures of normal family foods, just remember to avoid adding salt and sugar if you are cooking for your baby. A number of commercial baby foods are also available and many parents find them more convenient in certain situations.

Cooled, boiled water may be offered from an open cup or free-flow beaker. Cows milk should not be offered as a main drink until 1 year of age as it contains insufficient amounts of some key nutrients including iron.

Below are some of the symptoms of coeliac disease in infants. If you notice any of these symptoms you should make an appointment with your GP and discuss coeliac disease testing.

• Diarrhoea

• Stools often yellow and foul smelling

• Lower than expected weight gain

• Generally unhappy/irritability

• Muscle wasting

• Abdominal swelling

• Poor appetite