title: Mucosal healing in patients with celiac disease and outcomes of pregnancy: a nationwide population-based study.
abstract: OBJECTIVE
  Studies have associated undiagnosed celiac disease with adverse outcomes of pregnancy. We investigated the association between persistent villous atrophy and outcomes of pregnancy in women with celiac disease.
  
  
  METHODS
  We collected data on 337 women with celiac disease who gave birth (to 460 infants) within 5 years of a follow-up biopsy, from 28 pathology departments in Sweden. We compared birth outcomes from women whose follow-up biopsy showed persistent villous atrophy (Marsh score, 3; n = 142; 31% of study population) with those of women with mucosal recovery (n = 318; 69%). We used multivariable logistic regression (adjusted for maternal age, parity, country of birth, smoking, infant sex, and calendar year of birth) to evaluate the association between persistent villous atrophy and pregnancy outcomes.
  
  
  RESULTS
  Intrauterine growth restriction occurred during 3.5% of pregnancies in women with persistent villous atrophy vs 3.8% of those with mucosal healing (adjusted odds ratio [OR], 0.61; 95% confidence interval [CI], 0.19-1.99). There was no significant association between persistent villous atrophy and low birth weight (OR, 0.98; 95% CI, 0.41-2.39), preterm birth (OR, 1.66; 95% CI, 0.72-3.83), or cesarean section (OR, 0.86; 95% CI, 0.51-1.46).
  
  
  CONCLUSIONS
  Although undiagnosed celiac disease has been associated with adverse outcomes of pregnancy, we found no evidence from a nationwide population-based study that persistent villous atrophy, based on analysis of follow-up biopsies, increases risk compared with mucosal healing.
authors.affiliation: Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Stephansson
authors.affiliation: Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: jonasludvigsson@yahoo.com.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006651:Histocytochemistry; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D047928:Premature Birth / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Autoimmunity; Childbirth; Epidemiology; Gluten; Inflammation