Five miscarriages. That is what Mummy Charlotte had to endure before finally being able to go full term pregnant and safely deliver her son Nate. She credits this life-sized breakthrough mainly to the gluten-free diet that she adopted before conceiving again, and that she adhered to for the duration of her sixth pregnancy.

Which leads to the question, does gluten negatively affect pregnancy?

Can this protein that is found in grain products cause miscarriages?

The answer is yes, and the threat is most serious when gluten intolerance and pregnancy are present at the same time; pregnant women with undiagnosed coeliac disease can lead to losing your baby. Here's how it happens.

WHAT HAPPENS WHEN UNDIAGNOSED GLUTEN INTOLERANCE AND PREGNANCY MEET?

MORE LIKELY TO MISCARRY

According to Braverman IVF & Reproductive Immunology, a full-service fertility centre based in New York, USA, coeliac disease is one of the most common autoimmune disorders related to pregnancy loss, and that statistically, women with undiagnosed coeliac disease are significantly more prone to miscarriage than women without the disorder.

Undiagnosed coeliac disease in the pregnant woman also increases the risk of anaemia and preterm labour.

Gluten Intolerance Group (GIG), a California, USA-based non-profit organisation that advocates gluten-free living, has the same finding: mothers-to-be with undiagnosed coeliac disease are at higher risk for miscarriage, infertility, and low birth weight babies.

This can be attributed to immune-mediated processes and to nutrient deficiencies, said registered dietitian nutritionist Lola O'Rourke, an education coordinator at GIG.

TRIGGERED BY GLUTEN

Coeliac disease, O'Rourke explained, is an auto-immune disease wherein the body's immune system reacts to gluten by damaging the small intestine, consequently preventing it from absorbing nutrients properly.

This could lead to malnutrition and allied ailments, which is detrimental to the pregnant mum and her growing baby who both need a great deal of nutrients for optimal health and development.

Some symptoms of coeliac disease are bloating, abdominal pain, chronic diarrhoea, vomiting, indigestion, constipation, fatigue, skin rashes, bone and joint pain, tingling and numbness in the hands and feet, difficulty getting pregnant and unexpected weight loss.

Ask your doctor about coeliac disease testing if you experience these symptoms, have an adverse reaction to food with gluten or have had concerns about fertility or pregnancy loss. You must be on a regular diet, not on a gluten-free one, when getting tested for coeliac disease so that the doctor can ascertain how your body reacts to gluten and thus make an accurate diagnosis.

BLOOD TEST AND BIOPSY

Samples of your blood will be analysed during coeliac disease testing. The doctor might order an endoscopy as well, depending on the results of your blood test. An endoscopy allows the doctor to view your small intestine and to take a tissue sample from it to analyse for damage via a tiny camera inserted into the body.

You could be diagnosed with coeliac disease or just gluten sensitivity. The latter, also called non-celiac gluten sensitivity, has similar general and gut-related symptoms to coeliac disease and lactose intolerance. Unlike coeliac disease, however, gluten sensitivity does not damage the small intestine when gluten is present in the body.

GOING GLUTEN-FREE

Coeliac disease has no known cure but it can be controlled by avoiding all sources of gluten and removing this protein completely from your diet. Following a gluten-free diet can stop symptoms, heal intestinal damage, and improve overall health.

Do note that gluten can be found not just in food like barley, rye, wheat, malt, pasta, French fries, soups, and soy sauce. It is also an ingredient in a few everyday items too like lip balms, medicines, and vitamins.

O'Rourke's advice is to always consult with your personal healthcare team regarding your unique nutrient and dietary needs, especially during pregnancy when the requirements for nutrients like iron, folic acid, and calcium are way greater.

This is even more imperative if you are a mother-to-be who has been diagnosed with coeliac disease and has to strictly follow a gluten-free diet.

If you're worried that a gluten-free diet is lacking in nutrients or is substandard compared to your normal diet, don't be. "Generally speaking, by substituting gluten-containing grains with gluten-free whole grains, a gluten-free diet can be as nutritious as a diet that contains gluten," O'Rourke pointed out.

YOU CAN EAT THESE

Examples of whole grains that are safe to include in a gluten-free diet and can provide the fibre, minerals, and vitamins you need are:

• corn/polenta
• quinoa
• gluten-free oats
• buckwheat
• rice
• millet
• sorghum
• teff
• amaranth

Other healthy, gluten-free food that can be eaten while pregnant are:

• vegetables
• fruits
• salads
• nuts
• beans
• lentils
• red meat
• chicken
• eggs
• fish

ALSO READ: Gluten-free diets: Separating wheat from the chaff

To get the most nutrients out of your food:

• Cook vegetables lightly. Steam or bake instead of frying.
• Eat foods "whole" and in their natural form as much as possible. Starchy vegetables like potatoes, sweet potatoes, squash, and green peas, for example, are already high in carbohydrates and are thus better off without added fats, sugar or sodium.
• Go for variety and colour. Try different kinds of fruits and vegetables for tastier and healthier snacks and meals.
• Read food labels and use only gluten-free ingredients.
• Ask help from a dietitian on planning and preparing your meals and make sure to follow his/her recommendations.

Taking mummy Charlotte's hard-learned lesson of undiagnosed gluten intolerance and pregnancy into account, we hope this gives you a heads up on what coeliac disease is and how you can avoid gluten during your pregnancy.

This article was first published in theAsianparent.