Are you pregnant and have gluten intolerance?

Some nutritional points to bear in mind through your pregnancy

Coeliac disease is a medical condition. Those who suffer from coeliac disease have a permanent intolerance to gluten, a protein found in wheat, rye, oats and barley.

Pregnant women who have coeliac disease are faced with special problems. During pregnancy and for the first few weeks after birth (if breastfed), the baby is taking all his nourishment from the mother. It is important for the proper development of the baby that all his nutritional needs are met during this time. It is the nutritional quality of the diet that is important and not the kilojoule intake. Don't 'eat for two'. For a woman of average weight, a normal gain during pregnancy would be 10 to 13 kg.

Nutritional imbalance has most impact on the foetus during the first trimester (first 13 weeks).

Good nutrition is important at all times but especially during pregnancy. During this time, there is an especial need for certain nutrients such as calcium, folate and iron. There is very little needed in the way of increased energy (kilojoules).

  • Folate is a Group B vitamin which is needed for healthy growth and development. Folate also prevents neural tube defects such as spina bifida. For those with coeliac disease, folate can be supplied from many fruits and vegetables, gluten free wholegrain breads and cereals, nuts and foods with folate additives. Check with your doctor who will probably suggest a folate supplement. Be careful to check that any supplements that are considered are gluten free. Asparagus, avocados, oranges, sunflower seeds, spinach, broccoli, legumes and black beans are all high in folate.
  • Iron is needed in greater than normal amounts during the last 2 trimesters of pregnancy. Iron deficiencies in pregnancy are relatively common and can be more harmful to the mother than to the baby. There are two types of iron. Haem iron is obtained from meat, fish or chicken and is readily absorbed by the body.

Non-haem iron is found in legumes, wholegrain breads and cereals, lentils and tofu. It is less easily absorbed but its absorption can be helped by consuming some vitamin C along with non-haem iron products. Even small amounts of meat with a mainly vegetarian meal will aid absorption. If you don't eat meat, try to drink half a glass of orange juice with your meal or adding a few slices of a citrus fruit to a vegetarian stir-fry. Just as ingesting some vitamain C with your meal will aid absorption of non-haem iron, so the consumption of tea or coffee with a meal will inhibit its absorption.

  • Calcium is needed by the foetus for the development of strong bones and teeth. By far the richest sources of calcium are dairy products. Should there be an allergy or intolerance to dairy products, a calcium enriched alternative should be sourced. Rice and soy based products are good choices. Look for products that have around 300mg of calcium per 250ml serving. Tinned salmon and sardines are also high in calcium, particularly if the soft bones are consumed.
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Vegans who have coeliac disease need to ensure they are meeting all the nutritional needs of themselves and their unborn baby. Consultation with a specialist is recommended to ensure that a healthy diet is being eaten. It is important to maintain protein levels. Intakes of Vitamin D, Vitamin B6, zinc and Vitamin B12 also need to be monitored. Vegan products fortified with B12 can be purchased and a B12 supplement of this type will be needed as this vitamin is only found in foods derived from animals.

Because coeliac disease compromises the immune system, pregnant women are at risk of contracting listeriosis. Listeriosis occurs when the bacterium Listeria monocytogenes contaminates food which is then consumed. Listeriosis can cuase miscarriage in the first trimester and acute illness or stillbirth in the second and third trimesters. The most common culprits are chilled foods and those foods that have been prepared or stored under less than hygienic conditions.

To less the risk of contracting listeria, avoid unpasteurised or raw milk products. The listeria bacterium is destroyed by cooking but meats must be thoroughly cooked. Don't eat meats that have any sign of pink flesh or that have blood oozing from them. Choose only freshly cooked meats. Don't purchase takeaway cooked or chilled meats. Don't eat liver products (such as pates), delicatessen meats or salads, or raw seafoods. Hot food should be served piping hot and cold food cold. Keep stored food at under 5oCelsius. Listeria bacteria multiply rapidly at temperatures between 5o Celsius and 60o Celsius.

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Wash fruit and vegetables before consumption and eat immediately. Don't use the same utensils, cutting boards and storage containers for raw and cooked foods. Keep the two separate. Pay strict attention to good hygiene practices in food preparation areas and always wash your hands thoroughly before and after preparing food.

While there might seem cause for concern when a woman with coeliac disease becomes pregnant, it is perfectly possible to meet all the needs of both mother and child during this time. All that is needed is knowledge of what is required in the diet and how to source it.