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Review
. 2024 Sep 21;16(18):3194.
doi: 10.3390/nu16183194.

Exploring the Impact of Folic Acid Supplementation and Vitamin B12 Deficiency on Maternal and Fetal Outcomes in Pregnant Women with Celiac Disease

Lily Lev  1 , Katherine Petersen  1 , Joseph L Roberts  1   2 , Kevin Kupferer  1 , Steven Werder  1
Affiliations
Review

Exploring the Impact of Folic Acid Supplementation and Vitamin B12 Deficiency on Maternal and Fetal Outcomes in Pregnant Women with Celiac Disease

Lily Lev et al. Nutrients. .

Abstract

Background: Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten, affecting approximately 1% of the global population and two million Americans. An increasing number of studies have identified a link between celiac disease and adverse maternal and fetal outcomes during pregnancy and after birth. Additionally, both celiac disease and pregnancy are associated with an increased risk for nutrient deficiencies, specifically vitamin B12 and folate. Methods: This review examines the current literature related to the folate trap and vitamin B12 deficiency in patients with celiac disease and pregnant women independently and provides rationale for future research to explore the relationship between the folate-to-12 ratio in pregnant women with celiac disease. Results: Deficiencies in vitamin B12 are linked with several negative maternal and fetal health outcomes including pre-eclampsia, gestational diabetes, spontaneous abortion/miscarriage, preterm birth, neural tube defects, intrauterine growth restriction, and low gestational age and birthweight. Conclusions: Folic acid supplementation is widely recommended during pregnancy, but complementary vitamin B12 supplementation is not standard. Physicians should consider celiac disease screening during pregnancy as well as vitamin B12 supplementation.

Keywords: celiac disease; folate; folic acid; pregnancy; vitamin B12.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Rationale for subpopulation of interest.
Figure 2
Figure 2
Folate and methionine metabolism. The conversion of 5-methyltetrahydrofolate (5-MTHF) to tetrahydrofolate (THF) is halted when there is a vitamin B12 deficiency. This inhibits the methionine cycle and leaves elevated homocysteine (Hcy) levels in the blood.
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