It is important that people with coeliac disease are followed up regularly, particularly at times of stress, for example, pregnancy.
There is an increased risk of reproductive problems in women with untreated coeliac disease. If a gluten-free diet is not followed, it can lead to a low birth weight baby, an increased risk of having a preterm baby and an increased likelihood of requiring a caesarean section.
Depending on individual assessment and diet, supplementation with calcium, iron, and vitamin B12 may be required. It’s best to get vitamins and minerals from the food you eat, but when you are pregnant you may need to take some supplements as well.
If you have any concerns, it may be helpful to see a dietitian, who can assess your diet and ensure you are getting enough nutrients for you and your baby.
Folic acid supplements are recommended for women during the three months before conception and the first 12 weeks of pregnancy. The recommendation for the general population is 400µg folic acid, but a higher level of 5mg folic acid is recommended for women with coeliac disease as a precaution in case of ongoing malabsorption.
This recommendation is made by National Institute for Health and Care Excellence (NICE) and is endorsed by our Health Advisory Council.
Folic acid is important during 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 and the recommendation for a higher folic acid level during pregnancy is precautionary in case you have damage in the gut which could reduce absorption of vitamins such as folic acid.
The higher dose of 5mg a day will not be available over the counter and would need to be prescribed by your GP. We would therefore recommend contacting your GP to discuss this guidance and your prescription of folic acid.
It’s possible that folic acid supplementation may mask the symptoms of vitamin B12 deficiency, which is more common in people with coeliac disease. It’s 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.
It is also recommended that you take 10 micrograms of vitamin D each day throughout your pregnancy.