Coeliac disease

• Gluten enteropathy - sensitivity to dietary gluten (protein component of wheat and other cereals) leads to villous atrophy of the small bowel and mal-absorption

• Incidence 1:3000

• Presents with malaise, diarrhoea, weight loss and mal-absorption syndromes

• Endomysial and anti-gliadin antibodies useful but small bowel biopsy required for definitive diagnosis

• Treatment by gluten-free diet

• Untreated or poorly treated celiac disease associated with :

delayed menarche, 
amenorrhoea, 
sub-fertility, 
recurrent miscarriage, 
neural tube defects (folate deficiency), 
anaemia (iron and folate deficiency) and 
osteomalacia. 

- Fetus at risk of neonatal hypocalcaemia

• Strict pre-pregnancy control with supplementation of folic acid, iron, and B vitamins.

• Monitor vitamin and iron replacement during pregnancy

• Vitamin K mal-absorption may lead to coagulopathy - check PT at 36 weeks and administer vitamin K if necessary