ABSTRACT
Objetivo: Revisar os dados já publicados sobre a associação entre doença celíaca materna e desfechos gestacionais desfavoráveis (nascimento de recémnascidos com baixo peso, prematuros e pequenos para idade gestacional) e sua relação com a dieta isenta em glúten. Fontes dos dados: Revisão sistemática feita nas bases de dados do PubMed e da Biblioteca Virtual em Saúde. Incluídos estudos de coorte que compararam a incidência de desfechos gestacionais desfavoráveis em mulheres com doença celíaca tratadas e não tratadas com dieta isenta em glúten. A validade interna dos estudos foi avaliada pelos critérios Strobe. Síntese dos dados: Doença celíaca materna não tratada esteve associada ao nascimento de recémnascidos de baixo peso, prematuros e pequenos para a idade gestacional. Quando tratada, o risco desses desfechos se aproximou do encontrado na população sem doença celíaca. Conclusões: Doença celíaca materna não tratada esteve associada a desfechos gestacionais desfavoráveis. A dieta isenta em glúten parece aproximar o risco desses desfechos ao encontrado em mulheres saudáveis.(AU)
Aim: To review the published data on the association between maternal celiac disease and adverse pregnancy outcomes and its relationship to glutenfree diet. Sources: A systematic review of Biblioteca Virtual em Saúde (LILACS, IBECS, MEDLINE, SciELO, and Cochrane) and PubMed databases was performed. Cohort studies that compared the incidence of adverse pregnancy outcomes in women with treated and untreated celiac disease were included in the analysis. STROBE criteria was used to assess the internal validity of the studies. Summary of the findings: Maternal untreated celiac disease was associated with premature births, low birthweight and small for gestational age. When celiac disease was treated, the risk of these outcomes was similar that found in people without celiac disease. Conclusions: Untreated maternal celiac disease was associated with adverse pregnancy outcomes. Treatment with glutenfree diet reduced significantly the risk of these outcomes, making the rate similar to that observed on women without celiac disease.(AU)
Subject(s)
Humans , Female , Celiac Disease/complications , Celiac Disease/diet therapy , Diet, Gluten-Free/statistics & numerical data , Pregnancy OutcomeABSTRACT
Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Its prevalence in Europe and the USA is 0.5 to 1 percent. Aim: To analyze epidemiological aspects and degree of compliance with gluten-free diet (GFD) among Chilean individuals with CD. Material and Methods: Subjects with confirmed or suspected CD were invited to answer an online survey published on the web at www.fundacionconvivir.cl. The answers were reinforced with a telephone interview. Results: The survey was answered by 1212 subjects (79 percent females). Median age at diagnosis was 25.8 years (range 1 to 84 years), with a bimodal curve with two peaks at less than 3 years and at 20 to 40 years of age. The diagnosis was made only by serologic markers in 9 percent, only by intestinal biopsy in 17.5 percent, and by a combination of both methods in 70 percento. Conditions associated with CD were reported by 30 percent> of subjects and 20 percent> had relatives with CD. The GFD was strictly adhered to by 70 percent>, occasionally by 27 percent> and never by 3 percent>. Seventy five percent of subjects with a strict adherence to GFD had a favorable clinical response compared with 42 percent> of those with incomplete or lack of adherence (odds ratio 4.0, 95 percent> confidence intervals 2.8-5.7p < 0.01). Conclusions: In 30 percent of respondents, the diagnosis of CD was not confirmed according to international guidelines that require serology and duodenal biopsy. One third of subjects recognized a poor compliance with GFD. Those with a strict adherence to it had a more favorable clinical course. However, 25 percent> did not experience a clinical improvement despite a strict GFD, a finding which requires further study.