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As a result of the discussion a few weeks ago on spina bifida and CD,
I sent the following message to the CEL-PRO list, a private list for
professionals treating and researching celiac disease (CD):
 
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Date: September 14, 1995  2:52 pm
 
There was a post on the CELIAC list recently which suggests a
complication of [untreated] CD of which I had not previously heard.
I'll try to summarize that post:
 
A young mother, who is quite thin, "...was diagnosed with sprue [CD] in
high school, but she got over it."  (This, of course, is nonsense.)
She has a young daughter with spina bifida.  The post suggested a
possible link between spina bifida and low maternal folic acid.  The
question raised in the post is:  Could the spina bifida in the
daughter have been caused by malabsorption of folic acid in the mother
during pregnancy, with the malabsorption being a direct result of
untreated celiac disease in the mother?  If that is the case, then we
have a child inflicted with a life-long condition due to untreated CD
during pregnancy.  Meanwhile the young mother could easily have
another child, and is apparently unaware that she still has (and
always will have) the sprue [CD] she thought she got over in high
school.
 
I wonder how many other birth defects relating to nutritional
deficiencies during pregnancy might be caused by celiac-related
malabsorption.  Does this connection seem plausible?  Are there any
studies comparing birth defects for untreated celiac mothers with
birth defects in the population at large?  Could such information be
easily gathered?
 
I'd welcome any comments you may have on this topic.  If there is a
correlation between birth defects and untreated CD, I think it would
be a powerful motivator for celiac women of childbearing age to not
cheat on the diet.  People who won't take care of themselves will
often go to extraordinary lengths to protect their current and future
children.  It would also demonstrate the importance of screening the
US population for celiac disease, even in the absence of apparent
symptoms.
 
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There were several responses to this message.  I received permission
from two of the doctors to widely distribute their responses; these I
will repeat here for you. The first came from Dr. Markku Maki, a
Professor of Pediatrics at the University of Tampere in Finland.  He was
one of the speakers at the Baltimore conference.  Dr. Maki's response:
 
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From: Markku Maki, MD
Date: September 15, 1995  5:25 am
 
Jim Lyles wrote:
 
>The question raised in the post is:  Could the spina bifida in the
>daughter have been caused by malabsorption?....I'd welcome any
>comments you may have on this topic.
 
At the Celiac Disease Study Group in Tampere, we want to respond.  We
have discussed this lately and we are going to do an inquiry to the
Finnish Coeliac Disease Society members about this.  Dr. Kati Holm has
a case you might be interested in:
 
The first child of the mother suffered from spina bifida and
meningomyelocele (boy). Two pregnancies that followed resulted in
abortion because of intrauterine diagnosis (confirmed meningomyelocele
at autopsy).  During the fourth pregnancy anemia and folic acid
deficiency were noticed.  The mother was treated with vitamins, folic
acid and iron.  The pregnancy resulted in a healthy girl.  After this
there were again several abortions because of detected menigmyelocele.
The mother contacted Dr. Kati Holm (PhD on celiac disease) because of
diarrhea and anemia and subsequently celiac disease screening tests
were performed among other studies.  IgA class reticulin autoantibody
tests were positive and a jejunal biopsy revealed the typical lesion
for celiac disease.  She was prescribed a gluten-free diet, after
which symptoms disappeared.  The iron and folic acid deficiencies
disappeared at the same time as the mucosa recovered.  One pregnancy
resulted, without any other therapy, in a healthy child.
 
All this by chance alone??
 
Prof. Markku Maki
Institute of Medical Technology
University of Tampere
P.O. Box 607
FIN-33101 Tampere, Finland
 
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The other response came from Dr. Karoly Horvath, Associate Professor
of Pediatrics and director of the Pediatric Gastrointestinal &
Nutrition Laboratory at University of Maryland:
 
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From: Karoly Horvath, MD, PhD
Date: September 17, 1995  5:47 pm
 
The relation between folate deficiency and neural tube defects is well
documented. Several studies have demonstrated a significant reduction
of neural tube defects in the newborns of  folate supplemented
pregnant woman. The risk reduction varies between 58-91%. The
different studies used different supplementation and doses. A recent
review article summarizes the up-to-date information in this subject
(Czeizel AE, "Folic acid in the prevention of neural tube defects",
Journal of Pediatric Gastroenterology and Nutrition 20: 4-16, 1995).
 
The other association between folate deficiency and absorptive problem
is not questionable, and does not need to be proven.
 
I do not have any doubt that that the babies of women with
non-diagnosed CD have an increased risk for neural tube defects.  We
can collect information retrospectively,  however, it will not be easy
and convincing.  A prospective study is easier if we found a center
treating mostly children with neural tube defects and we can get blood
samples from the mother shortly after giving birth for folate level
determination and celiac serologic tests.
 
Karoly Horvath
University of Maryland
 
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Thank you to Drs. Maki and Horvath for sharing their knowledge with us
on this important topic.
 
--
-- Jim Lyles
-- [log in to unmask]
-- Holly, Michigan, USA
--