Two Gluten-free Buns in the Oven
Some of my most perceptive readers picked up on clues along the way that something was different with me lately. The uncharacteristic meat sandwich I devoured in San Francisco was one (I craved the protein and iron)… and the fact that I was blogging about things like tea and berries and supplements rather than actual food (too nauseous to cook) apparently was another.
Indeed, it would seem that I am pregnant–with twins, no less (!)–and am fumbling my way through my first gluten-free pregnancy… and all of the food cravings, aversions and additional requirements that come along with it.
While I pledge not to turn this blog into a full-fledged mommy blog, I did want to devote a few posts to cover issues regarding pregnancy and nutrition– and address dealing with pesky GI issues that crop up along the way (if God had an angel on earth, he would be my beloved acupuncturist, Michael Bennett, M.S., L.Ac., Dipl. O.M, who nixed my pregnancy-related nausea and constipation faster than I could inhale a jar of pickles. Is that TMI?).
Pregnancy for Celiacs
The first trimester is a precarious time in any pregnancy, and certainly no less so than for women with celiac disease. While our nutritional needs are the same as for other women, there are some special concerns we need to be particularly tuned into to help ensure the best possible outcomes for ourselves.
- Pregnancy is the time to recommit to a strict gluten-free diet. Recurrent miscarriages are one sign of undiagnosed celiac disease, as are adverse fetal outcomes like intrauterine growth retardation and low birth weight. Conversely, celiac women who have been diagnosed prior to conception and follow a gluten-free diet appear not to be at any significantly greater risk than other women. The evidence, then, highlights the critical importance of compliance with a strict version of the diet. Most of us who have been following a GF diet for some time have determined which risky eating behaviors we feel we can “get away with”: for me, it’s been sharing a toaster oven with my husband and stealing french fries (that likely shared a fryer with all manner of battered and breaded appetizers) off of other peoples’ plates when out at restaurants. Given the risks associated with the with such dietary indiscretions during pregnancy, however, I’ve had to clean up my eating act and go back to the gluten-free basics: interrogating waiters when out, being hypervigilant about cross-contamination at home, and passing when I have even a shred of doubt about a sauce, a condiment or a cooking method. I would recommend the same to any client of mine with celiac disease who is trying to become pregnant or is currently pregnant.
- Make sure your pre-natal vitamin is gluten-free. Several over-the-counter brands are explicitly labeled as such, but you may need to do some
digging into your prescription brand by calling the manufacturer. Also, if a vitamin contains “modified food starch” as an inactive ingredient you should assume it contains gluten and find an alternative.
- Get your folic acid. While this applies to ALL women who are attempting to conceive and who are pregnant, I highlight this point for celiac women in particular because our gluten-free flours, breads, pastas and cereals are almost never fortified with folic acid like conventional products are. If you’re not consistently taking a folic acid supplement (all pre-natal vitamins should contain between 600 mcg to 1 mg), know that you don’t have the same “safety net” as most women do by virtue of the folic-acid-fortified food supply. Folic acid is required for proper DNA replication of all the millions of new cells developing in your baby, and deficiency in early pregnancy is associated with an increased risk of neural tube (brain and spinal cord) defects.
- Ask your doctor to check your Vitamin D status. Again, in my opinion, this applies to ALL women who are attempting to conceive, who are pregnant and who are breastfeeding, but I highlight this point for celiac women in particular because celiac disease is an autoimmune condition for which we pass on genes to our offspring. A compelling body of evidence has emerged in the past decade linking Vitamin D “insufficiency” in moms (in geeky lab terms: blood levels of 25(OH)D < 32 ng/mL) to an increased rate of autoimmune disorders, including Type I diabetes (whose genes are related to celiac disease), multiple sclerosis and even asthma. (Interestingly, epidemiological evidence shows that babies born in winter–whose mothers were pregnant during the sunny summer months–have lower incidence rates of autoimmune conditions compared to babies born in the summer to moms who were pregnant in the wintertime. This observation has been attributed to the presumably better improved Vitamin D status of moms with regular exposure to the sun during their summer pregnancies.) My personal experience has been that many (most?) OB-GYNs do not emphasize the importance of Vitamin D status during pregnancy, and certainly don’t offer to test you for it as a matter of course. What’s more, your insurance company is not likely to cover the cost of the test since it’s not routine; I chose to pay $145 in lab fees out of pocket anyway, because that’s how important I believe it to be. Data consistently show that the majority of women of childbearing age do not have sufficient Vitamin D levels in their blood, and vitamin D status tends to decrease during pregnancy even further–even among women whose pre-natal vitamins contain the standard 400 IU dose. In smaller studies, some experts have found that it can take doses of up to 4,000-6,000 IU/day in certain pregnant women (particularly women of color) to achieve sufficient blood levels! This is why I feel its important to have your levels checked before pregnancy–or early into your pregnancy– so that you can tailor an appropriate sun-and-supplementation strategy with your doctor or dietitian to help you achieve sufficiency and help reduce the risk that your child’s autoimmune disease genes will express themselves. Since my levels were just shy of sufficient when I was tested in March, I upped my daily dose from 1,000 IU to 2,000 IU (on top of the 400 IU in my pre-natal vitamin) until June rolled around and I was getting at least 10-15 minutes per day of unprotected sun exposure on my arms. Come September, I’ll go back to my daily 2,000 IU dose for the duration of my pregnancy and for as long as I am breastfeeding.