Ask An Expert Question: Is there any connection between celiac disease and preeclampsia? I have celiac disease (CD), and I wondered if this elevated my risk for PE/HELLP (which I did get).

 

ANSWER: The short answer is "no;" the largest meta-analysis of this question to date included almost 5 million women and found no differences in the rate of preeclampsia when women with CD were compared to women without it. That said, women with CD were at higher risk of a number of other obstetric complications, including intrauterine growth restriction (where the fetus is considerably smaller than is normal for gestational age) and stillbirth. Some of these risks were lowered considerably when the woman was diagnosed and treated with a gluten-free diet. Long answer: Celiac disease is an autoimmune response within the small intestine to the presence of a protein called gluten present in many cereal grains. In people with the disease, eating gluten triggers an immune response to one of the body’s proteins called “tissue transglutaminaise”, a common enzyme and transcription factor present in cells. This causes the immune system to attack its own cells. Preeclampsia also seems to be related to a different immune response to an implanting pregnancy, but this immune response isn’t quite autoimmune, even though autoimmune conditions can raise risk of preeclampsia. It is a response to the foreign proteins from the cells that will go on to form the placenta, which is not part of the mother’s body. It is also not strictly speaking what we think of when we think of allergic or autoimmune responses! It is a part of the immune system that exists to respond to the arrival of the trophoblast and to work with those trophoblast to form a placenta. Women with symptoms of celiac disease will want to bring this up with their care providers, who can diagnose the condition or other factors leading to similar symptoms.