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Coeliac Disease and Pregnancy

In this Part 3 article for Dietetic Care, Kyann Calvi, Accredited Practicing Dietitian, provides some helpful advice on coeliac nutritional requirements during pregnancy.

Coeliac Disease and Pregnancy

During pregnancy, and also at the time after birth when you may breastfeed, you are your baby’s only source of nourishment, so you need to make sure that the best quality food sources reach them! There are special nutritional requirements throughout the different stages of pregnancy, including prior to conception. The fetus is most susceptible to nutritional imbalance during the first trimester of pregnancy (first 13 weeks).

In part 1 entitled ‘Coeliac Disease Where Do I Start’ I advised on Coeliac Disease including diagnosis, sources of gluten and management of the life long gluten free (GF) diet. For those of you that have not read that article please do so prior to reading this one. As previously advised Coeliac Disease (CD) is a medical condition caused by a permanent intolerance to gluten, a protein mostly found in wheat, rye, barley and oats. In response to readers’ requests I have decided to cover special food considerations for Coeliacs during pregnancy.

Important Nutrients

Good nutrition during pregnancy will help to keep you healthy, and your baby developing at the rate it should be. The need for certain nutrients such as folate, iron and calcium is increased or emphasised at this time but only a small amount of extra energy (kilojoules) is needed.

Folate - The most important nutrient prior to conception and during the first trimester is folate - a B group vitamin needed for division of cells for healthy growth and development, and prevention of neural tube defects such as Spina Bifida. Folate can be obtained from many fruits and vegetables, GF wholegrain breads and cereals, nuts and foods fortified with folate. However, it is recommended that a folate supplement be taken in addition to a healthy diet. If you’re planning to start a family in 2008, make sure you adopt a healthy lifestyle regime and commence folate supplementation for a few months prior to conceiving. The current RDI (recommended dietary intake) for folate during pregnancy is 600ug (micrograms NOT milligrams). Always ensure that nutritional supplements are GF before taking them!

GF Folate rich foods include - asparagus, avocadoes, broccoli, black beans, GF cereals fortified with folate, legumes, oranges, sunflower seeds, spinach and GF Vegespread (TM).

Iron - Pregnant women need extra iron during the last 2 trimesters (about 10mg more per day than non- pregnant women), to provide iron stores for the baby. Iron deficiency during pregnancy is quite common and may be more harmful to the mother than the infant. Include iron rich food sources in your diet to prevent iron deficiency. There are two different types of iron 1) haem iron from meat, chicken or fish and 2) non-haem iron from legumes, lentils, tofu, wholegrain breads & cereals. Haem iron is readily absorbed by the body however non-haem sources are less well absorbed. Foods rich in Vitamin C (e.g. citrus fruits) and meat (even in small amounts) increase iron absorption from non-haem sources. Add a few slices of citrus fruit to your vegetable stir fry or drink half a glass of orange juice with your vegetarian meal to increase iron absorption. Alternatively, drinking tea and coffee with iron containing meals will inhibit the absorption of non-haem iron.

Calcium - The current National Health & Medical Research Council guidelines suggest that pregnant women consume 1,000mg calcium/day (14-18 year olds need 1,300mg/d) to ensure their baby is born with strong bones and teeth. Dairy products are by far the richest dietary sources of calcium and you can achieve the above recommendation (women over 18 years of age) by eating or drinking three serves of dairy or calcium rich alternative a day. One serve is equal to 250mls milk, 200g yoghurt or 40g hard cheese. For people who are allergic or intolerant to dairy products it is extremely important to choose dairy alternatives that are calcium enriched such as rice or soy based products (i.e. milk, yoghurt, custard and ice cream). When choosing an alternative to cow’s milk look for products that have approximately 300mg of calcium per 250ml serving. Other foods that are high in calcium include tinned salmon and sardines, especially if you eat the soft bones!

Energy – There’s no need to “eat for two” during your pregnancy. During the first trimester a woman’s kilojoule intake should be about the same as it was pre-pregnancy. During the second and third trimester energy needs only increase about 10% or an extra 600kj which is the equivalent to an extra 2 slices of gluten free bread (based on an average 35g slice). Remember it’s the nutritional quality of the diet not the kilojoule intake that’s important!

It’s a good idea to eat according to your appetite and monitor your weight. A normal pregnancy weight gain is around 10-13kg.

Note: The above recommendations are for women that are a healthy pre-conception weight, recommendations vary for those that are either underweight or overweight pre-conception.

The Vegan Coeliac and Pregnancy

As well the other recommendations made in this article, vegans need to ensure they consume sufficient protein, Vitamin D (or have 10 mins in the sun 2-3 times per week), vitamin B6, zinc and use a vitamin B12 supplement, as B12 is only found in foods derived from animals or vegan products fortified with B12 e.g. some soy beverages. A consultation with an APD working in gastrointestinal diseases, vegetarianism and pregnancy is recommended.

What do I need to be aware of?

Listeria Infections (Listeriosis)

Pregnant women, newborn infants and people with depressed immune symptoms are at risk of developing listeriosis as a result of eating food contaminated by the bacterium Listeria monocytogenes. Listeriosis can cause miscarriage during the first trimester and acute illness or stillbirth during the second and third trimesters. Listeria is found mainly in foods that are chilled and ready to eat and can be found in foods that are NOT hygienically prepared or stored.

Suggestions to minimise your risk of Listeria

  • Avoid unpasteurised or raw milk products such as soft serve ice cream and soft cheeses eg. fetta, brie, camembert and ricotta – Note: Listeria is destroyed by conventional cooking, so soft cheeses are safe if cooked and served hot.
  • Eat only freshly cooked meats (including seafood) – there should NOT be any uncooked sections i.e. no pink or clear meat (seafood) and definitely no blood!
  • Avoid liver products such as pates.
  • Eat hot food steaming hot.
  • Keep cold food cold (below 5°celsius) and hot food hot (above 60°celsius). The bacteria that commonly cause food poisoning grow very well between 5and 60°celsius.
  • Avoid all takeaway cooked and chilled meat or deli meats, salad bars or prepared salads.
  • Fruit and vegetables should be washed thoroughly and eaten immediately.
  • Keep utensils and food preparation areas clean.
  • Separate raw and cooked foods and don’t use the same utensils (especially cutting boards and knives) for preparation, storage and serving.
  • Avoid raw seafood such as oysters, sashimi, smoked salmon or oysters (canned oysters are safe).
  • Wash and dry hands thoroughly before and after the preparation of foods.

Mercury in Fish may harm your baby

Fish are a great source of protein and minerals, low in saturated fat and contain omega-3 fatty acids for brain and central nervous system development. Some fish contain high levels of mercury which can affect your baby’s developing nervous system. Research is ongoing, but women should be selective about the types and amounts of fish they eat during pregnancy. The following table will help you to identify the best types of fish to eat and how often.

There’s no need to worry if you’ve had the occasional meal of fish with high levels of mercury, it’s only a potential problem when that type of fish is eaten regularly and there is a build-up of mercury in your blood.

Alcohol – Current research suggests that alcohol should be avoided throughout all stages of pregnancy as there is no safe level of alcohol consumption. Drinking even a small amount of alcohol while pregnant can cause brain damage to your baby or what’s known as Foetal Alcohol Spectrum Disorder. No alcohol = no risk.

Caffeine – should be limited to no more than 2 cups of coffee per day (1 if it’s espresso/percolated). Tea, cola flavoured drinks and chocolate should also be limited. Some studies suggest that heavy caffeine consumption (>300mg/day) can increase risk of spontaneous abortion and that babies can experience caffeine withdrawal after birth.

Herbal Products - some herbal preparations including tablets, liquids, herbal teas and essential oils should be avoided during pregnancy. See your GP or Obstetrician for further details.

Pregnancy Supplements
A multivitamin and mineral supplement specifically formulated for pregnancy and breastfeeding may be recommended by your GP, Obstetrician or Dietitian.

A HEALTHY GLUTEN FREE MENU FOR PREGNANCY*

Breakfast: ½ - ¾ cup of GF cereal PLUS 1-2 tsp of psyllium husks or dissolvable fibre supplement PLUS 125mls fat reduced milk or calcium fortified dairy alternative

Morning Tea: 1 piece fresh fruit (150g portion)
OR 30-40g raw nuts and seeds

Lunch: 1 x Multigrain GF sandwich with salad and & hard cheese

Afternoon Tea: 1 x 200g tub fat reduced dairy/soy yoghurt
OR 2 x GF rice cakes/cruskits + hard cheese OR GF savoury spread

Dinner: 80-120g cooked salmon/lean red or white meat/tofu OR 2 eggs
PLUS 2 cups of cooked vegetables OR 3 cups of salad + 3/4cup of legumes
PLUS 2 cups of GF pasta OR 3/4cup of DoongaraTM, BasmatiTM rice

Supper: 1 cup of fat reduced dairy/alternative custard with 150g freshly chopped fruit
*Please consider the above recommendations when planning your menu.

Things to remember:

  • The need for specific nutrients changes just prior to pregnancy, during pregnancy and while breastfeeding
  • Nutrition and safe food handling are extremely important to prevent complications with your pregnancy
  • Your baby is counting on you to provide the best quality nourishment for their growth and development

This article has briefly addressed some of the issues that women with CD are faced with before during and after pregnancy. Consultation with your APD, GP and or Obstetrician is recommended.


Kyann Calvi is an Accredited Practising Dietitian (APD) who specialises in Food Allergy/Intolerance, Coeliac Disease and other gastrointestinal disorders such as Irritable Bowel Syndrome. For the past seven years she has helped people with food allergies/intolerance meet their nutrient needs through special diets. Kyann works in private practice locations in the Eastern suburbs of Melbourne. Contact Us

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