Pregnancy

Planning a pregnancy?

If you are planning a pregnancy it is important to eat well; this will give your baby the best possible start in life. There are no specific dietary guidelines for pregnant women with coeliac diseaseA condition where a person is unable to eat gluten as it makes their body attack itself. . It is important to stick to the gluten-freeWhen a food has less than 20 parts per million (ppm) of gluten so it is safe for people with coeliac disease to eat. diet and make sure you’re having a good intake of iron and calcium. If a glutenA protein that is found in the cereals wheat, barley and rye. -free diet is not followed this can lead to a low birth weight baby. There is an increased risk of reproductive problems in untreated coeliac disease.

It is best to get vitamins and minerals from the food you eat but when you are pregnant you will need to take some supplements as well.

Folic acid

The Department of Health recommends that all women take a folic acid supplement of 400 micrograms a day for three months before conception and for the first three months of pregnancy to protect against neural tube defects (NTDs) such as spina bifida. There is no evidence to suggest that people with coeliac disease are more at risk of NTDs.

If your folic acid levels are low before conception, you may need to take a higher dose of 5 milligrams a day. This should be discussed with your GPGeneral Practitioner, or local doctor.

It is possible that folic acid supplementation may mask the symptoms of vitamin B12 deficiency, which is more common in people with coeliac disease. It is important that you stay in regular contact with your healthcare team during your pregnancy so they can monitor you.

As well as a supplement, you should choose foods high in folate (the natural form of folic acid) such as green leafy vegetables.

Vitamin D

It is recommended you take 10 micrograms of vitamin D each day throughout your pregnancy and if you breastfeed. This is recommended to prevent rickets in your baby.

Iron

Your need for iron increases during pregnancy, so make sure you’re having plenty of iron rich foods whilst pregnant. It is also good to build up your body’s iron stores before you become pregnant. Lean meat, fish, pulses (lentils and beans) and eggs are rich sources along with dark green leafy vegetables. Some women may need iron supplements but these should only be taken as prescribed, on medical advice from your GP.

Calcium

It is recommended that adults with coeliac disease have more calcium in their diet to help prevent the loss of this essential mineral from bones. Milk and dairy products are especially good sources of calcium and easily absorbed. If you eat soya alternatives check they have added calcium.

Other sources include:

• green leafy vegetables
• kidney beans
• sardines (with the bones)
• dried fruit, particularly figs
• tofu (tofu is naturally gluten-free but marinated tofu products may contain gluten so it is best to check).

Including these foods in your diet will help you meet your requirements.

Supplements

If you choose to take a multivitamin supplement during pregnancy, make sure it does not contain vitamin A, as high levels can be harmful to your unborn baby. Fish liver oil supplements contain vitamin A so should be avoided.

Eat at least 5-a-day

Aim to have at least five portions of a variety of fruit and vegetables each day. These give you a range of vitamins and minerals, they are high in fibre, make great snacks and are naturally gluten-free. Fresh, frozen, canned, dried and juiced all count. Juice counts as a maximum of one portion each day, however much you drink.

Fill up on starchy foods

Starchy, gluten-free foods such as cornmeal, brown rice and jacket potatoes are great sources of energy and fibre and help to keep you feeling fuller for longer. They should make up the main part of each meal.

Protein

Good sources of protein include meat, fish, eggs, pulses, dhal and tofu (tofu is naturally gluten-free but marinated tofu products may contain gluten so it is best to check). Many of these foods are also good sources of iron. Include foods from this group every day. 

Oily fish is great for the development of your baby’s nervous system and eyes, but you should not eat more than two portions a week because they can contain pollutants, which can harm your baby.

Weight gain

If you’re a normal weight for your height, you should gain at least 10 – 14kg of weight over the whole pregnancy. It is important not to go on a crash diet at this time. Instead find a balance so you don’t lose weight during your pregnancy but you also don’t gain too much weight and avoid foods high in fat and/or sugar such as chocolate and crisps. 

Constipation

Constipation can be a problem during pregnancy. To avoid this, eat gluten-free high fibre and seeded breads, fruit, vegetables and pulses, and drink plenty of water.

Foods to avoid

Some foods need to be avoided during pregnancy as they can carry high levels of bacteria, which if eaten, increase the risk of infection and harm to the baby.

You should avoid:

• Raw and partially cooked eggs and dishes containing these, for example, homemade mayonnaise.
• Raw shellfish.
• Raw and undercooked meats and chicken.
• Soft ripened cheeses such as Camembert and Brie. 
• Blue veined cheeses including Stilton and Danish Blue.
• All unpasteurised dairy products.
• All types of pate including vegetable.
• Shark, marlin and swordfish – these types of fish contain high levels of mercury, which can damage your baby’s developing nervous system.  

Liver and liver products such as pate and faggots contain high levels of vitamin A which can be harmful to your unborn baby and should not be eaten during pregnancy.

Caffeine

During pregnancy aim to have no more than 200mg of caffeine a day which is equal to:

• two mugs of instant coffee
• one mug of filter coffee
• two mugs of tea
• five cans of cola, or
• four (50g) bars plain chocolate (milk chocolate contains less caffeine than plain chocolate).

Alcohol

It is best to avoid alcohol completely during pregnancy and especially if you are planning a pregnancy and during the first three months. If you do choose to have alcohol this should be limited to one or two units once or twice a week.

Financial help

If you are on certain benefits you can apply for the Healthy Start scheme from 10 weeks of pregnancy. If eligible you receive weekly vouchers to exchange for milk, fruit or vegetables and you can also receive free Healthy Start vitamins.

During pregnancy it is important to stick to your gluten-free diet to protect both you and your baby. If you have any concerns, it may be helpful to see a dietitianAn expert in food and nutrition. , who can assess your diet and ensure your nutritional intake is adequate.