Brittney Elliott1, Nicholas Czuzoj-Shulman2, Andrea R Spence2, Daniel S Mishkin3, Haim Arie Abenhaim1,2. 1. Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada. 2. Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada. 3. Division of Gastroenterology, Atrius Health, Boston, MA, USA.
Abstract
PURPOSE: Celiac disease (CD) is a permanent immune reaction to gluten that is likely related to genetic factors. Some studies have linked CD to adverse maternal and/or neonatal outcomes but the data has been contradictory. The purpose of this study was to evaluate the effect of CD on pregnancy outcomes. MATERIALS AND METHODS: We used data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) of the USA to conduct a population-based retrospective cohort study of women who delivered between 1999 and 2014. Pregnancies were categorized as having CD if corresponding ICD-9 code was present. Unconditional logistic regression models were used to estimate the adjusted effect on maternal and fetal outcomes. RESULTS: There were 14,513,587 births during the study period of which 2755 were to women with CD, for an overall prevalence of 1.9 cases/10,000 births and with rates increasing over the study period. Women with CD tended to be older, Caucasian and to have pre-existing comorbidities, especially other autoimmune diseases. Women with CD were at greater risk of hyperemesis gravidarum, 4.52 (3.68-5.57), Clostridium difficile colitis, 7.56 (3.14-18.20), and venous thromboembolic events, 2.93 (2.07-4.15), as well as, hospital stays >3 d, 2.06 (1.75-2.43). Infants of women with CD were more likely to be growth restricted, 1.80 (1.46-2.21) and have congenital malformations, 3.51 (2.68-4.58). CONCLUSIONS: CD in pregnancy is associated with increased adverse maternal and newborn complications. These pregnancies should be considered high risk and may benefit from increased surveillance.
PURPOSE: Celiac disease (CD) is a permanent immune reaction to gluten that is likely related to genetic factors. Some studies have linked CD to adverse maternal and/or neonatal outcomes but the data has been contradictory. The purpose of this study was to evaluate the effect of CD on pregnancy outcomes. MATERIALS AND METHODS: We used data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) of the USA to conduct a population-based retrospective cohort study of women who delivered between 1999 and 2014. Pregnancies were categorized as having CD if corresponding ICD-9 code was present. Unconditional logistic regression models were used to estimate the adjusted effect on maternal and fetal outcomes. RESULTS: There were 14,513,587 births during the study period of which 2755 were to women with CD, for an overall prevalence of 1.9 cases/10,000 births and with rates increasing over the study period. Women with CD tended to be older, Caucasian and to have pre-existing comorbidities, especially other autoimmune diseases. Women with CD were at greater risk of hyperemesis gravidarum, 4.52 (3.68-5.57), Clostridium difficile colitis, 7.56 (3.14-18.20), and venous thromboembolic events, 2.93 (2.07-4.15), as well as, hospital stays >3 d, 2.06 (1.75-2.43). Infants of women with CD were more likely to be growth restricted, 1.80 (1.46-2.21) and have congenital malformations, 3.51 (2.68-4.58). CONCLUSIONS: CD in pregnancy is associated with increased adverse maternal and newborn complications. These pregnancies should be considered high risk and may benefit from increased surveillance.