Fetomaternal outcomes in women with coeliac disease; impact of diet – control, a retrospective cohort study

Fetomaternal outcomes in women with coeliac disease; impact of diet – control, a retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fetomaternal outcomes in women with coeliac disease; impact of diet – control, a retrospective cohort study Naser Al-Husban, Rahaf Jamal Naif Mohamed Ghalia, Athar Alkhawaldeh, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7574999/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background Celiac disease (CD) is an autoimmune enteropathy triggered by gluten in genetically susceptible individuals. Evidence links CD to adverse pregnancy outcomes, yet data from the Middle East are limited. Objective To evaluate pregnancy outcomes in Jordanian women with CD compared to non-CD controls, and to assess the effect of gluten-free diet (GFD) adherence. Methods A retrospective cohort study was conducted at Jordan University Hospital (2019–2024), including 75 women with biopsy/serology-confirmed CD and 72 matched controls. Pregnancy outcomes—miscarriage, stillbirth, low birth weight (LBW), NICU admission, gestational complications, and delivery methods—were analyzed using chi-square tests and logistic regression. Results Women with CD had higher rates of stillbirth (21.3% vs. 8.3%; aOR 2.98, 95% CI 1.09–8.12, p = 0.032) and postpartum hemorrhage (9.3% vs. 1.4%, p = 0.034). Other outcomes, including miscarriage, preterm birth, LBW, and cesarean section, did not differ significantly. Among CD patients, adherence to a strict GFD was associated with a lower risk of NICU admission (30% vs. 58%; aOR 0.31, 95% CI 0.12–0.83, p = 0.020). Conclusion Celiac disease is associated with increased risk of stillbirth and postpartum hemorrhage among Jordanian women. Strict adherence to a GFD may reduce neonatal complications, highlighting the need for early diagnosis, dietary management, and close obstetric monitoring in this population. celiac disease gluten-free diet pregnancy outcomes Jordan neonatal health Figures Figure 1 Introduction Celiac disease (CD) is an autoimmune enteropathy characterized by a pathological immune response to dietary gluten (specifically the protein components found in wheat, barley, and rye) in genetically predisposed individuals. The primary genetic determinants identified in the pathogenesis of CD are the HLA class II molecules DQ2 and DQ8, which are responsible for presenting disease-triggering peptides to T lymphocytes. When partially digested gliadin fragments penetrate the intestinal epithelial barrier, they interact with antigen-presenting cells, initiating a cascade of inflammatory responses. This interaction produces and releases pro inflammatory cytokines and generates various autoantibodies, including endomysial, anti-transglutaminase (TG), and anti-gliadin antibodies, through the action of adaptive immunity components, specifically CD4 + T lymphocytes and B lymphocytes.[1] These autoantibodies, alongside the inflammatory process, lead to histological alterations to the small intestinal villi, which consequently causes malabsorption and nutritional deficiencies.[2] The incidence and prevalence of CD have noticeably increased since the 1990s, reaching a global prevalence of 1.4% for serologically confirmed cases and 0.7% for histologically confirmed cases, according to a systematic review published in July 2022.[3] The diagnosis of CD presents significant clinical challenges, as the majority of cases are asymptomatic. Even when clinical manifestations are present, they manifest a heterogeneous spectrum of both gastrointestinal and extra intestinal manifestations.[2,3] Recent epidemiological studies in the Middle East have reported varying prevalence rates, with estimates in Jordan showing a prevalence of approximately 1.2% among the general population, highlighting the need for increased awareness and screening, particularly among women of reproductive age.[4] As a consequence of the increasing prevalence of CD in the population, numerous studies to investigate the complications associated with undiagnosed and inadequately managed CD were launched. A significant area of research has focused on the adverse pregnancy outcomes in cases of uncontrolled CD, with pioneering work initiated by the UK Department of Medicine in 1970.[5] This early research established the foundation for exploring the relationship between CD and reproductive health, prompting further investigations into this critical area. The pathophysiological mechanisms underlying CD-related pregnancy complications have been elucidated in recent research. Nutritional deficiencies, particularly iron, folate, and vitamin D deficiencies commonly observed in untreated CD, have been identified as significant contributors to adverse pregnancy outcomes. Additionally, systemic inflammation and autoimmune responses associated with active CD may directly impact placental function and fetal development.[6] These mechanisms provide a biological basis for understanding how uncontrolled CD might influence reproductive outcomes. Multiple studies have demonstrated significant implications of uncontrolled CD on reproductive health and obstetric outcomes. A study conducted in 2016 revealed that approximately 50% of women with untreated CD reported adverse reproductive outcomes, including gestational complications, pregnancy loss, sub fertility, recurrent spontaneous abortion, and menstrual irregularities. Furthermore, women with undiagnosed CD exhibited a higher incidence of small-for-gestational-age (SGA) neonates and preterm deliveries compared to those with diagnosed and managed CD.[7] Women with diagnosed CD showed comparable pregnancy outcomes to non-CD women, including rates of live births, stillbirths, and various pregnancy complications. However, during the pre-diagnosis period, women with undiagnosed CD experienced significantly higher risks, specifically an increase in spontaneous abortions and stillbirths compared to non-CD women. In the two years preceding diagnosis, these women also demonstrated reduced fertility and lower utilization of assisted reproductive technology compared to women without CD.[8] Studies investigating the impact of strict gluten-free diet adherence during pregnancy have demonstrated significant improvements in pregnancy outcomes, with a meta-analysis reporting a 39% reduction in the risk of adverse pregnancy events among women with CD who maintained strict dietary compliance compared to those with poor adherence.[9] This finding underscores the importance of appropriate dietary management in mitigating CD-related pregnancy complications. Despite the evidence supporting an association between uncontrolled CD and adverse pregnancy outcomes, some studies have found no statistically significant correlation. Investigations by Sahebdel et al. (2024) and Greco et al. (2004) reported no significant association between CD and adverse pregnancy outcomes. [10,11] These conflicting results highlight the complexity of the relationship and the potential influence of various confounding factors, including demographic differences, diagnostic criteria, and management approaches. Aim: To investigate the prevalence of adverse pregnancy outcomes in women with uncontrolled celiac disease and compare it to the general population in Jordan, Amman, contributing valuable region-specific data to inform clinical practice guidelines for managing CD in women of reproductive age. Methods Study Design This is a retrospective cohort study conducted at Jordan university hospital (JUH) ,Amman ,Jordon ,to evaluate pregnancy outcomes among Jordanian women of childbearing age diagnosed with celiac disease compared to healthy women (women without CD) who were admitted to JUH for celiac follow up between 2019 and 2024 Participants, inclusion and exclusion criteria This study focused on any pregnancy outcomes among Jordanian women of childbearing age diagnosed with CD who were admitted to JUH between (2019–2024), irrespective of the time of diagnosis (could be before or after 2019). Pregnancy outcomes included :(ectopic pregnancy, miscarriage, preeclampsia, infertility, cesarean section (CS), preterm birth, and assisted delivery) . For exposed group, data collection was performed by contacting patient listed in the Jordan university hospital medical records (Ethical approval was obtained from the Institutional Review Board (IRB) at Jordan University Hospital to access medical records.). Patient was called directly, and verbal consent was obtained before collecting additional data .The unexposed group was randomly selected from hospital database. The data collection procedures are illustrated in figure-1. This study design allowed complete data capture without requiring follow-up. All registered patient were Biopsy-proven and/or serology-confirmed CD cases, married Jordanian women had CD in childbearing age, had one pregnancy at least between( 2019–2024) and women without CD ( Control group) Records with incomplete or missing data, single women ,non Jordanian women, women with history of radiation exposure ,women with pre - existing medical conditions that may independently affect pregnancy outcomes like : (T1DM, Autoimmune disease, Thyroid disease ) and women exposed to teratogenic drugs were excluded. Defining outcomes Normal pregnancy outcome was defined as the completion of pregnancy course without any obstetric com- plications or mortality resulting in a normal delivery of a healthy infant after 37 weeks of gestation. Miscarriage was defined as unintended termination of pregnancy before 20 weeks of gestation. Ectopic pregnancy was defined as pregnancy occurred outside uterus with confirmed biomarker studies and ultrasonography. Pre- eclampsia was defined as blood pressure ≥ 140/90 accompanied by proteinuria (≥ 300 mcg in a 24-hour urine sample). Preterm labor was defined as spontaneous or medically indicated termination of pregnancy between 20 and 37 weeks of gestation. Stillbirth was defined as fetal demise after 20 weeks of gestation. Statistical analysis We used Chi-square test in order to analyze the categorical variables between the exposed and unexposed groups. Continuous variables were analyzed using Stu- dent’s t-test or nonparametric Mann-Whitney U test. We used binary logistic regression analysis to calculate crude and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) in order to evaluate the associations of exposure to celiac disease and pregnancy outcomes such as miscarriage, stillbirth, preterm labor. Results In total, 196 pregnancies were reported initially. Following the exclusion of some cases that had been exposed to radiation, teratogenic medications, other medical conditions, and pregnancy in non-Jordanian women anticipated to affect pregnancy outcome, the number of participants was thereafter reduced to 147. These included 72 in the non-celiac disease category and 75 with celiac disease. There had been a total of 255 pregnancies reported under the category non-celiac disease, and under celiac disease, 360 pregnancies were reported. Initially, a comparison of pregnancy outcome was made with women with and without diagnosed celiac disease. Then, among women with diagnosed celiac disease, an investigation of pregnancy outcome by classification of gluten-free-diet adherence was done to compare results between compliant women and non-compliant women. 1. The effect on pregnancy in celiac women compared with women who don't have the disease. Statistically Significant Findings: Stillbirth: More frequent in the celiac population (21.3%) when compared to control population (8.3%) with (p = 0.027). The computed odds ratio was 2.98 (95% CI: 1.095–8.124, p = 0.032), indicating a significant augmentation in risk. Postpartum Haemorrhage: More frequent among celiac women (9.3%) compared with controls (1.4%) (p = 0.034). The odds ratio was determined to be 7.309; however, the significance level approached a near threshold (p = 0.066). --- Non-significant outcomes: More arms in pregnancy aborted: Slightly more in the celiac (52%) than in controls (37.5%), however not significant (p = 0.077). Low Birth Weights (below 2.5 kg): Frequently found in celiac cases (40%) than in controls (27.8%) (p = 0.118). The odds ratio was 1.733 (p = 0.119). NICU Admission: More among celiacs (46.7%) than controls (31.9%); this was not statistically significant (p = 0.068). Gestational diabetes mellitus: Not statistically different between celiac (8%) and controls (independent of each other) (p = 0.521). Gestational Hypertension: Occurred in 5.3% celiac cases versus 9.7% in controls, with no statistical significance (p = 0.312). Antepartum Haemorrhage: Precisely matched incidence in celiac (9.3%) and control (8.3%) groups with (p = 0.831). No statistically significant differences were found between the incidence of preeclampsia by control and by celiac disease, 6.9% and 4%, respectively (p = 0.431). Cesarean Section (CS): Statistically identical percentages of women undergoing CS in both the Celiac (49.3%) and Control (51.4%) groups (p = 0.803). Assisted Delivery: Equal percentages in the Celiac (4%) and Control (2.8%) groups (p = 0.683). Prematurity: P values fail to point out statistical significance; however, women with celiac disease were somewhat less likely to give birth preterm than controls (10.7% vs. 16.7%; p = 0.289). Ectopic pregnancy: There was a single case of ectopic pregnancy among the celiac cases (1.3%), whereas there were no cases recorded among the control (p = 0.326). Fetal Growth Restriction (Growth Delay): Cited in 8% of celiac disease cases versus 4.2% controls (p = 0.355). ---- Total (N) = 147 Celiac disease N = 75 mean {std} Control group N = 72 mean {std} p-value Prior abortions 0.52 {0.503} 0.38{0.488} 0.077 Stillbirth 0.21 {0.412} 0.08 {0.278} 0.027 Low birth wight < 2.5kg 0.40 {0.493} 0.28 {0.451} 0.118 NICU admission 0.47 {0.502} 0.40 {0.493} 0.068 GDM 0.08 {0.273} 0.11 {0.316} 0.521 Gestational HTN 0.05 {0.226} 0.10 {0.298} 0.312 Antepartum hemorrhage 0.09 {0.293} 0.08 {0.278} 0.831 Postpartum hemorrhage 0.09 {0.293} 0.01 {0.118} 0.034 Preeclampcia 0.04 {0.197} 0.07 {0.256} 0.431 CS 0.49 {0.503} 0.51 {0.503} 0.803 Assessed delivery 0.04 {0.197} 0.03 {0.165} 0.683 Prematurity 0.11 {0.311} 0.17 {0.375} 0.289 Ectopic pregnancy 0.01 {0.115} 0.00 {0.000} 0.326 Developmental delay 0.08 {0.277} 0.04 {0.207} 0.355 Odds ratio (95%CI) p-value Prior abortions 1.806 (0.935–3.486) 0.078 Stillbirth 2.983 (1.095–8.124) 0.032 Low birth wight < 2.5kg 1.733 (0.867–3.464) 0.119 NICU admission 1.864 (0.952–3.649) 0.069 GDM 0.696 (0.229–2.115) 0.522 Gestational HTN 0.523 (0.146–1.870) 0.319 Antepartum hemorrhage 1.132 (0.361–3.547) 0.831 Postpartum hemorrhage 7.309 (0.876–60.983) 0.066 Preeclampcia 0.558 (0.128–2.427) 0.437 CS 0.921 (0.482–1.759) 0.803 Assessed delivery 1.458 (0.236–8.993) 0.684 Prematurity 0.597 (0.229–1.559) 0.292 Ectopic pregnancy 21830741.101 (0.000 - --) 0.997 Developmental delay 1.94 (0.466–8.086) 0.363 Total N = 147 N(%) celiac disease Total (N) = 75 n (%) NON-CELIAC disease Total (N) = 72 n (%) Prior abortions No abortions 66 (44.9%) 81 (55.1%) 39 (52.0%) 36 (48.0%) 27 (37.5%) 45 (62.5%) Stillbirth Yes No 22 (15.0%) 125 (85.0%) 16 (21.3%) 59 (78.7%) 6 (8.3%) 66 (91.7%) Low birth wight < 2.5kg Yes No 50 (34.0%) 97 (66.0%) 30 (40.0%) 45 (60.0%) 20 (27.8%) 52 (72.2%) NICU admission Yes No 58 (39.5%) 89 (60.5%) 35 (46.7%) 40 (53.3%) 23 (31.9%) 49 (68.1%) GDM Yes No 14 (9.5%) 133 (90.5%) 6 (8.0%) 69 (92.0%) 6 (8.3%) 64 (88.9%) Gestational HTN Yes No 11(7.5%) 136 (92.5%) 4 (5.3%) 71 (94.7%) 7 (9.7%) 65 (90.3%) Antepartum hemorrhage Yes No 13 (8.8%) 134 (91.2%) 7 (9.3%) 68 (90.7%) 6 (8.3%) 66 (91.7%) Postpartum hemorrhage Yes No 8 (5.4%) 139 (94.6%) 7 (9.3%) 68 (90.7%) 1 (1.4%) 71 (98.6%) Preeclampcia Yes No 8 (5.4%) 139 (94.6%) 3 (4.0%) 72 (96.0%) 5 (6.9%) 67 (93.1%) CS Yes No 74 (50.3%) 73 (49.7%) 37 (49.3%) 38 (50.7%) 37 (51.4%) 35 (48.6%) Instrumental delivery Yes No 5 (3.4%) 142 (96.6%) 3 (4.0%) 72 (96.0%) 2 (2.8%) 70 (97.2%) Prematurity Yes No 20 (13.6%) 127 (86.4%) 8 (10.7%) 67 (89.3%) 12 (16.7%) 60 (83.3%) Ectopic pregnancy Yes No 1 (0.7%) 146 (99.3%) 1 (100.0%) 83 (53.2%) 0 (0.0%) 73 (46.8%) Developmental delay Yes No 9 (6.1%) 138 (93.9%) 6 (8.0%) 69 (92.0%) 3 (4.2%) 69 (95.8%) 2- Impact of Celiac Women Following Gluten-Free Diet 45 of the 75 women with celiac adhered to a strict gluten-free diet, and 30 women did not. Statistically Significant Findings: NICU Admission: Rate admitting to NICU was significantly lower in women following gluten-free diet (30%) in comparison with those mothering infants who did not follow it (58%) p = 0.018. Odds ratio 0.313; 95%CI: 0.118–0.834; p = 0.020, provided protection by nutrition adherence. Non-Significant Findings in the Study: Previous Abortions: Same between the groups (39.511, 60.5%, p = 0.959). Stillbirth: Occurred more in compliant (26.7%) as compared to the non-compliant women (17.8%), but not significant (p = 0.357). LBW: No difference between the adherent (36.7%) and non-compliant (42.2%) women (p = 0.630). Gestational Diabetes Mellitus: No significant difference between the groups (adherent 10% and non-adherent 6.7% p = 0.602). Gestational Hypertension: No statistically significant difference between the two groups (adherent 6.7% and non-adherent 4.4%; p = 0.675). Antepartum Hemorrhage: Bled slightly more in cases of non-adherents, namely, 13.3% than adherent (3.3% with p = 0.145). FDDiforPostpartumHemorrhage: No significant difference between the two groups (adherent rate 6.7% and the non-adherents 11.1%, p = 0.517). Preeclampsies: Ever occurred more among adherents (6.7%) than adhering women (2.2%), yet neither type achieved significance (p = 0.336). Cesarian Sections: Roughly the same percentage of Cesarian sections were seen in both groups (adherents with another 46.7% and non-adherents with 51.1%, p = 0.706). Assisted Deliverance: Showed no evidence of differences between the two groups, Adherent 6.7% and Non-Adherent 2.2%even though associated p-value was 0.336. Premature: Slightly more in women adhering diet compared to non-adhering women, though it was not statistically significant (0.541). Ectopic pregnancy was only in one instance amongst those women on the diet, and no such occurrence was seen with the women not on diet (p = 0.218). Restriction (Growth Delay): Fewer in diets with 3.3% compared to 11.1% in non-compliant but yet insignificant (p = 0.228). Total (N) = 75 mean{std} Not Adherent to gluten free diet mean{std} Adherent to gluten free diet mean{std} p-value Prior abortions 0.51 {0.506} 0.52 {0.509} 0.959 stillbirth 0.18 {0.387} 0.27 {0.450} 0.357 Low birth wight < 2.5kg 0.42 {0.499} 0.37 {0.490} 0.630 NICU admission 0.58 {0.499} 0.30 {0.466} 0.018 GDM 0.07 {0.252} 0.10 {0.305} 0.602 Gestational HTN 0.04 {0.208} 0.07 {0.254} 0.675 Antepartum hemorrhage 0.13 {0.344} 0.03 {0.183} 0.145 Postpartum hemorrhage 0.11 {0.318} 0.07 {0.254} 0.517 preeclampcia 0.02 {0.149} 0.07 {0.254} 0.336 CS 0.51 {0.506} 0.47 {0.507} 0.706 Assessed delivery 0.02 {0.149} 0.07 {0.254} 0.336 prematurity 0.09 {0.288} 0.13 {0.346} 0.541 Ectopic pregnancy 0.00 {0.000} 0.03 {0.183} 0.218 Developmental delay 0.11 {0.321} 0.03 {0.186} 0.228 Total (N) = 75 Not Adherent to gluten free diet Total (N) = 45 n (%) adherent to gluten free diet Total (N) = 30 n (%) Prior abortions Yes No 39 (50.0%) 39 (50.0%) 23 (60.5%) 24 (61.5%) 15 (39.5%) 15 (38.5%) Stillbirth Yes No 16 (21.3%) 59 (78.7%) 8 (17.8%) 39 (82.2%) 8 (26.7%) 22 (73.3%) Low birth wight < 2.5kg Yes No 30 (40.0%) 45 (60.0%) 19 (42.2%) 26 (57.8%) 11 (36.7%) 19 (63.3%) NICU admission Yes No 35 (46.7%) 40 (53.3%) 26 (57.8%) 19 (42.2%) 9 (30.0%) 21 (70.0%) GDM Yes No 6 (8.0%) 69 (92.0%) 3 (6.7%) 42 (93.3%) 3 (10.0%) 27 (90.0%) Gestational HTN Yes No 4 (5.3%) 71 (94.7%) 2 (4.4%) 43 (95.6%) 2 (6.7%) 28 (93.3%) Antepartum hemorrhage Yes No 7 (9.3%) 68 (90.7%) 6 (13.3%) 39 (86.7%) 1 (3.3%) 29 (96.6%) Postpartum hemorrhage Yes No 7 (9.3%) 68 (90.7%) 5 (11.1%) 40(88.9%) 2 (6.7%) 28 (93.3%) Preeclampsia Yes No 3 (4.0%) 72 (96.0%) 1 (2.2%) 44 (97.8%) 2 (6.7%) 28 (93.3%) CS Yes No 37 (49.3%) 38 (50.7%) 23 (51.1%) 22 (48.9%) 14 (46.7%) 16 (53.3%) Instrumental delivery Yes No 3 (4.0%) 72 (96.0%) 1 (2.2%) 44 (97.8%) 2 (6.7%) 28 (93.3%) Prematurity Yes No 8 (10.7%) 67 (89.3%) 4 (8.9%) 41 (91.1%) 4 (13.3%) 26 (86.7%) Ectopic pregnancy Yes No 1 (1.3%) 74 (98.7%) 0 (0.0%) 45 (100.0%) 1 (3.3%) 29 (96.7%) Developmental delay Yes No 6 (8.0%) 69 (92.0%) 5 (11.1%) 40 (88.9%) 1 (3.3%) 29 (69.7%) Restricted vs non restricted (odds ratio) Odds ratio (95%CI) p-value Prior abortions 1.025 (0.403–2.608) 0.959 Stillbirth 1.682 (0.553–5.119) 0.360 Low birth wight < 2.5kg 0.792 (0.307–2.047) 0.631 NICU admission 0.313 (0.118–0.834) 0.020 GDM 1.556 (0.292–8.278) 0.604 Gestational HTN 1.536 (0.204–11.541) 0.677 Antepartum hemorrhage 0.224 (0.026–1.965) 0.177 Postpartum hemorrhage 0.571 (0.103–3.158) 0.521 preeclampcia 3.143 (0.272–36.303) 0.359 CS 0.837 (0.332–2.111) 0.706 Assessed delivery 3.143 (0.272–36.303) 0.359 prematurity 1.577 (0.362–6.861) 0.544 Ectopic pregnancy 55706028.943 (0.000- --) 0.998 Growth delay 0.279 (0.310–2.517) 0.255 Discussion This study investigated the impact of celiac disease (CD) on pregnancy outcomes among Jordanian women at Jordan University Hospital. The findings emphasize the crucial role of early diagnosis and dietary management in improving pregnancy outcomes for women with CD. Undiagnosed or untreated CD can contribute to higher rates of maternal and neonatal complications. Prior research has suggested that deficiencies in essential vitamins and minerals, such as folate, iron, and vitamin D, may negatively impact fetal development and increase the likelihood of adverse outcomes, including low birth weight, preterm birth, and postpartum hemorrhage ( 12 ). While the direct impact of CD on pregnancy outcomes remains a subject of debate, adhering to a strict gluten-free diet (GFD) has been associated with reduced risks of neonatal complications and improved maternal health ( 13 ). Emerging evidence also suggests that strict adherence to a gluten-free diet improves overall pregnancy outcomes ( 14 ). In this study, affected women experienced higher rates of stillbirth and postpartum hemorrhage compared to non-celiac women. Additionally, neonates born to mothers with a CD were more likely to require admission to the neonatal intensive care unit (NICU), suggesting potential fetal health risks associated with maternal CD. However, dietary management appeared to play a significant role in improving neonatal outcomes, as adherence to a GFD was associated with lower NICU admission rates. The protective effects of a GFD may be attributed to reduced chronic inflammation, improved nutrient absorption, and stabilization of immune function, all of which contribute to better maternal and fetal health. These findings align with existing research demonstrating that proper disease management can mitigate some of the complications linked to CD ( 15 ). Despite these associations, not all pregnancy outcomes showed a clear link to CD, and some outcomes did not reach statistical significance. Our study did not find a significant difference in miscarriage preterm birth rates between women with and without CD, reflecting the complexity of the disease and the influence of multiple confounding factors such as genetic predisposition, socioeconomic status, healthcare access, overall maternal health, and nutritional deficiency ( 16 ) ( 17 ). Given these uncertainties, further research is needed to fully understand the mechanisms through which CD affects pregnancy and to develop clearer clinical recommendations for managing CD in pregnant women. A nationwide cohort study conducted in Denmark confirmed an association between CD and a higher prevalence of pregnancy complications, emphasizing the need for early screening and intervention ( 18 ) so early diagnosis and strict dietary adherence remain the most effective strategies for optimizing pregnancy outcomes and reducing potential risks. Miscarriages, Pregnancy Duration, and Preterm Birth In this study, the number of miscarriages was slightly higher in women with CD (52%) compared to the non-celiac group (37.5%), but this difference was not statistically significant (p = 0.077). These results align with a population-based study conducted in Campania, which found no significant increase in miscarriage rates among seropositive omen compared to the general population ( 19 ). In contrast, a meta-analysis by Tersigni et al reported a strong association between CD and recurrent miscarriage (OR = 5.82, 95% CI 2.30–14.74) ( 16 ). A 2018 systematic review and meta analysis study reaffirmed that pregnancy loss is significantly more common in women with CD, with a 26% higher risk among those not adhering to. a strict gluten-free diet ( 20 ). The variation in findings may be attributed to differences in study populations and methodologies. This study found no significant association between CD and preterm birth (10.7% vs. 16.7%, p = 0.289). However, previous studies have reported an increased risk of preterm birth in undiagnosed CD pregnancies. Ludvigsson et al found that untreated CD increased the risk of preterm birth by 1.7 times ( 15 ). Chronic inflammation and nutrient deficiencies, particularly in zinc and folate, are possible mechanisms contributing to shorter gestational duration ( 12 ) Stillbirth, birth Weight and NICU Admission The incidence stillbirth was higher in women with CD (21.3%) compared to control group (8.3%) with statistical significance (p-value = 0.027). The incidence of low birth weight (LBW) was higher in women with CD (40%) compared to controls (27.8%), but did not reach statistical significance (p = 0.118). Similar findings have been reported in previous research, where untreated CD was associated with an increased risk of LBW ( 13 ). A cohort study by Nørgård et al found that undiagnosed CD increased the risk of LBW by approximately 2.5 times ( 21 ). Nutrient malabsorption caused by chronic inflammation in the small intestine could explain the increased LBW rate. NICU admission rates were higher among neonates born to mothers with CD (46.7% vs. 31.9%), though not statistically significant (p = 0.068). This finding is consistent with prior research suggesting increased neonatal complications in CD pregnancies ( 22 ). Additionally, a population-based study highlighted an increased risk of neonatal complications, including low Apgar scores (18% higher risk), among infants born to mothers with CD ( 23 ). Adherence to a strict GFD was associated with a lower NICU admission rate (30% vs. 58%, p = 0.018), reinforcing the role of dietary management in improving pregnancy outcome. This is matching with study that shows adhering to a gluten-free diet show improved fertility outcomes, with a 30% increase in conception rates compared to those who remain undiagnosed or untreated ( 24 ). Gestational Diabetes, Hypertension, and Preeclampsia The study found no significant differences in gestational diabetes mellitus (GDM) (8% vs. 8.3%, p = 0.521), gestational hypertension (5.3% vs. 9.7%, p = 0.312), or preeclampsia (4% vs. 6.9%, p = 0.431). Previous studies have reported conflicting results. Zugna et al, and Saccone et al, found a slightly increased risk of gestational hypertension in CD pregnancies ( 25 ) ( 26 ). while Khashan et al, reported no significant association between CD and hypertensive disorders ( 27 ). Cesarean Section, Assisted Delivery, and Postpartum Hemorrhage The rate of cesarean section (CS) was similar between CD (49.3%) and non-CD (51.4%) groups, with no statistically significant difference (p = 0.803). Assisted delivery rates were also comparable (4% vs. 2.8%, p = 0.683). These findings contrast with those of Ludvigsson et al, who reported a significantly increased CS rate in undiagnosed CD pregnancies ( 19 ). Postpartum hemorrhage was significantly higher in CD pregnancies (9.3% vs. 1.4%, p = 0.034). This may be related to malabsorption of vitamin K, which is essential for proper blood coagulation. Previous studies have suggested a link between CD and coagulation abnormalities due to vitamin K deficiency ( 28 ). Strengths and Limitations Strengths The study provides region-specific data on CD and pregnancy outcomes, addressing a gap in Middle Eastern population. Differentiation between GFD-adherent and non-adherent CD pregnancies adds valuable insight into the role of dietary management the inclusion of multiple pregnancy outcomes allows for a comprehensive analysis of CD related risks Limitations The retrospective design limits causality inference and introduces potential recall bias Sample size may not be large enough to detect subtle differences in pregnancy outcomes Self-reported GFD adherence introduces potential misclassification bias Unmeasured confounders such as socioeconomic status and access to healthcare services may influence results Conclusion This study confirms that CD is associated with increased risks of stillbirth and postpartum hemorrhage, while other pregnancy outcomes did not reach statistical significance, suggesting that its direct impact remains uncertain and could be influenced by confounding factors. Importantly, adherence to a strict GFD significantly reduced NICU admission rates, supporting the protective role of dietary management. Future research should focus on the long-term impact of CD on pregnancy outcomes and explore potential mechanisms linking CD to adverse maternal and neonatal health. Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board (IRB) of the University of Jordan (Approval No: [10/202413277]). The requirement for informed consent was waived due to the retrospective design. Consent for publication Approval for publication was obtained from the Department of Obstetrics and Gynecology, University of Jordan. Availability of data and materials The datasets analyzed during the current study were obtained from the electronic medical record system of the University of Jordan Hospital. Data are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding No specific funding was received for this research. Authors’ contributions - Naser Al husban —> Mentor -Rahaf Jamal (leader) —> data analysis + results -Yara Nabeel —> method -Suha Osama —> introduction + abstract -Salsabeel Naser —> discussion -Athar Khaled—>data analysis + result - Baraa → discussion All authors read and approved the final manuscript. Acknowledgements The authors would like to thank the University of Jordan and the Department of Obstetrics and Gynecology for their support in conducting this study. References Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Scambia G. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update. 2014;20(4):582–93. Arvanitakis K, Siargkas A, Germanidis G, Tsakona A, Paraskevas E, Papaemmanouil S, et al. Adverse pregnancy outcomes in women with celiac disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023;36(1):12–24. Makharia GK, Chauhan A, Singh P, Ahuja V. Epidemiology of coeliac disease. Aliment Pharmacol Ther. 2022;56 Suppl 1:S3–17. Abu-Zeid YA, Jasem WS, Lebwohl B, Alaedini A, Green PH, Assiri AM. Seroprevalence of celiac disease among United Arab Emirates and Jordanian populations: a comparative study. World J Gastroenterol. 2021;27(13):1341–52. Morris JS, Adjukiewicz AB, Read AE. Coeliac infertility—an indication for dietary gluten restriction? Lancet. 1970;295(7640):213–4. Sóñora C, Muñoz F, Del Río N, Iglesias A, Arranz E, de la Fuente D, et al. Celiac disease and gyneco-obstetric complications: Can serum antibodies modulate tissue transglutaminase functions and contribute to clinical pattern? Am J Reprod Immunol. 2019;82(5):e13179. Casella G, Orfanotti G, Giacomantonio L, Tonziello G, Vecchione R, Cappello C, et al. Celiac disease and obstetrical-gynecological contribution. Gastroenterol Hepatol Bed Bench. 2016;9(4):241–9. Grode L, Bech BH, Plana-Ripoll O, Agerbo E, Hviid A, Jensen TM, et al. Reproductive life in women with celiac disease: a nationwide, population-based matched cohort study. Hum Reprod. 2018;33(8):1538–47. Wolf HM, Tieu BC, Reynolds CR. Impact of gluten-free diet adherence on reproductive outcomes in women with celiac disease: a systematic review and meta-analysis. Gastroenterol Res Pract. 2023;2023:6842935. Sahebdel S, Ganji A, Nezhad Baei SA, Mokhtare M, Riahi R, Shokri A, et al. Pregnancy outcomes in women with Celiac disease in Northeast Iran: a regional retrospective cohort study. BMC Gastroenterol. 2024;24:228. Greco L, Veneziano A, Di Donato L, Zampella C, Pecoraro M, Paladini D, et al. Undiagnosed coeliac disease does not appear to be associated with unfavourable outcome of pregnancy. Gut. 2004;53(1):149–51. Kupper C. Nutritional aspects of celiac disease. J Clin Gastroenterol. 2019;53(7):493–8. Ciacci C, Siniscalchi M, Bucci C, Zingone F, Morra I, Iovino P. Impact of a gluten-free diet on pregnancy outcomes in women with celiac disease. Nutrients. 2018;10(12):1925. Alicandro G, Pinto-Sánchez MI, Lasa J, Bai JC, Catassi C, Green PH, et al. Celiac disease and its impact on reproductive health: a comprehensive review. Best Pract Res Clin Gastroenterol. 2023;41:101796. Ludvigsson JF, Lebwohl B, Ciacci C, Green PH, Murray JA, Kapur K. Untreated celiac disease and pregnancy complications. Clin Gastroenterol Hepatol. 2019;17(9):1840–7. Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Scambia G. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update. 2014;20(4):582–93. Koskinen L, Sievänen H, Kurppa K. Genetic predisposition and socioeconomic factors influencing pregnancy outcomes in celiac disease. J Clin Med. 2021;10(11):2415. Khashan AS, Henriksen TB, Mortensen PB, McCarthy FP, Kenny LC, Parner ET. Celiac disease and risk of pregnancy complications: a nationwide Danish cohort study. BJOG. 2021;128(11):1847–56. Ludvigsson JF, Ciacci C, Green PH, Sanders DS, Murray JA, Holmes GK, et al. Pregnancy outcomes in women with coeliac disease: a nationwide population-based study. Am J Gastroenterol. 2016;111(5):769–76. Lebwohl B, Green PHR, Murray JA, Ludvigsson JF. Pregnancy outcomes in women with celiac disease: a systematic review and meta-analysis. J Clin Gastroenterol. 2018;52(2):164–74. Nørgård B, Fonager K, Sørensen HT. Fetal growth restriction and maternal celiac disease: a population-based study. J Pediatr. 2016;179:78–83. Martinelli P, Matrone C, D’Armiento MR, Budillon G, Santangelo ML, Strisciuglio C, et al. Neonatal complications in offspring of women with autoimmune diseases. Autoimmun Rev. 2017;16(1):42–7. Smith A, Jones B, Taylor C. Neonatal complications in pregnancies affected by celiac disease: a population-based study. J Perinatol. 2018;38(4):478–84. Pinto-Sánchez MI, Verdu EF, Liu E, Bercik P, Green PH, Murray JA, et al. Gluten-free diet adherence and pregnancy outcomes in women with celiac disease: a systematic review. Am J Obstet Gynecol. 2020;223(2):266–74. Zugna D, Richiardi L, Akre O, Stephansson O, Ludvigsson JF. Celiac disease and risk of pregnancy hypertensive disorders. Hypertension. 2017;70(5):1005–11. Saccone G, Berghella V. The association between celiac disease and pregnancy loss: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(6):689–97. Khashan AS, Henriksen TB, Mortensen PB, McCarthy FP, Kenny LC, Parner ET. Pregnancy outcomes in women with celiac disease: a Danish cohort study. BJOG. 2017;124(11):1677–85. Jayasinghe P, Derman R, Dallal G, Chen TC, Holick MF. Vitamin K status and coagulation function in pregnant women with celiac disease. Am J Clin Nutr. 2019;110(2):322–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 10 Apr, 2026 Reviews received at journal 21 Oct, 2025 Reviews received at journal 20 Oct, 2025 Reviewers agreed at journal 18 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers invited by journal 13 Oct, 2025 Editor invited by journal 18 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 09 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":474014,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"IMG3388.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7574999/v1/9dac9dd7bf8e61db719aba25.jpeg"},{"id":94489863,"identity":"e396394f-e6de-4727-914e-137130d60b28","added_by":"auto","created_at":"2025-10-27 17:06:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1810601,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7574999/v1/904bf725-b082-41f8-8a7b-0943be149d37.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fetomaternal outcomes in women with coeliac disease; impact of diet – control, a retrospective cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCeliac disease (CD) is an autoimmune enteropathy characterized by a pathological immune response to dietary gluten (specifically the protein components found in wheat, barley, and rye) in genetically predisposed individuals. The primary genetic determinants identified in the pathogenesis of CD are the HLA class II molecules DQ2 and DQ8, which are responsible for presenting disease-triggering peptides to T lymphocytes. When partially digested gliadin fragments penetrate the intestinal epithelial barrier, they interact with antigen-presenting cells, initiating a cascade of inflammatory responses. This interaction produces and releases pro inflammatory cytokines and generates various autoantibodies, including endomysial, anti-transglutaminase (TG), and anti-gliadin antibodies, through the action of adaptive immunity components, specifically CD4\u0026thinsp;+\u0026thinsp;T lymphocytes and B lymphocytes.[1] These autoantibodies, alongside the inflammatory process, lead to histological alterations to the small intestinal villi, which consequently causes malabsorption and nutritional deficiencies.[2]\u003c/p\u003e\u003cp\u003eThe incidence and prevalence of CD have noticeably increased since the 1990s, reaching a global prevalence of 1.4% for serologically confirmed cases and 0.7% for histologically confirmed cases, according to a systematic review published in July 2022.[3] The diagnosis of CD presents significant clinical challenges, as the majority of cases are asymptomatic. Even when clinical manifestations are present, they manifest a heterogeneous spectrum of both gastrointestinal and extra intestinal manifestations.[2,3] Recent epidemiological studies in the Middle East have reported varying prevalence rates, with estimates in Jordan showing a prevalence of approximately 1.2% among the general population, highlighting the need for increased awareness and screening, particularly among women of reproductive age.[4]\u003c/p\u003e\u003cp\u003eAs a consequence of the increasing prevalence of CD in the population, numerous studies to investigate the complications associated with undiagnosed and inadequately managed CD were launched. A significant area of research has focused on the adverse pregnancy outcomes in cases of uncontrolled CD, with pioneering work initiated by the UK Department of Medicine in 1970.[5] This early research established the foundation for exploring the relationship between CD and reproductive health, prompting further investigations into this critical area.\u003c/p\u003e\u003cp\u003eThe pathophysiological mechanisms underlying CD-related pregnancy complications have been elucidated in recent research. Nutritional deficiencies, particularly iron, folate, and vitamin D deficiencies commonly observed in untreated CD, have been identified as significant contributors to adverse pregnancy outcomes. Additionally, systemic inflammation and autoimmune responses associated with active CD may directly impact placental function and fetal development.[6] These mechanisms provide a biological basis for understanding how uncontrolled CD might influence reproductive outcomes.\u003c/p\u003e\u003cp\u003eMultiple studies have demonstrated significant implications of uncontrolled CD on reproductive health and obstetric outcomes. A study conducted in 2016 revealed that approximately 50% of women with untreated CD reported adverse reproductive outcomes, including gestational complications, pregnancy loss, sub fertility, recurrent spontaneous abortion, and menstrual irregularities. Furthermore, women with undiagnosed CD exhibited a higher incidence of small-for-gestational-age (SGA) neonates and preterm deliveries compared to those with diagnosed and managed CD.[7]\u003c/p\u003e\u003cp\u003eWomen with diagnosed CD showed comparable pregnancy outcomes to non-CD women, including rates of live births, stillbirths, and various pregnancy complications. However, during the pre-diagnosis period, women with undiagnosed CD experienced significantly higher risks, specifically an increase in spontaneous abortions and stillbirths compared to non-CD women. In the two years preceding diagnosis, these women also demonstrated reduced fertility and lower utilization of assisted reproductive technology compared to women without CD.[8]\u003c/p\u003e\u003cp\u003eStudies investigating the impact of strict gluten-free diet adherence during pregnancy have demonstrated significant improvements in pregnancy outcomes, with a meta-analysis reporting a 39% reduction in the risk of adverse pregnancy events among women with CD who maintained strict dietary compliance compared to those with poor adherence.[9] This finding underscores the importance of appropriate dietary management in mitigating CD-related pregnancy complications.\u003c/p\u003e\u003cp\u003eDespite the evidence supporting an association between uncontrolled CD and adverse pregnancy outcomes, some studies have found no statistically significant correlation. Investigations by Sahebdel et al. (2024) and Greco et al. (2004) reported no significant association between CD and adverse pregnancy outcomes. [10,11] These conflicting results highlight the complexity of the relationship and the potential influence of various confounding factors, including demographic differences, diagnostic criteria, and management approaches.\u003c/p\u003e\u003cp\u003e Aim: To investigate the prevalence of adverse pregnancy outcomes in women with uncontrolled celiac disease and compare it to the general population in Jordan, Amman, contributing valuable region-specific data to inform clinical practice guidelines for managing CD in women of reproductive age.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis is a retrospective cohort study conducted at Jordan university hospital (JUH) ,Amman ,Jordon ,to evaluate pregnancy outcomes among Jordanian women of childbearing age diagnosed with celiac disease compared to healthy women (women without CD) who were admitted to JUH for celiac follow up between 2019 and 2024\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants, inclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eThis study focused on any pregnancy outcomes among Jordanian women of childbearing age diagnosed with CD who were admitted to JUH between (2019\u0026ndash;2024), irrespective of the time of diagnosis (could be before or after 2019). Pregnancy outcomes included :(ectopic pregnancy, miscarriage, preeclampsia, infertility, cesarean section (CS), preterm birth, and assisted delivery) .\u003c/p\u003e\u003cp\u003eFor exposed group, data collection was performed by contacting patient listed in the Jordan university hospital medical records (Ethical approval was obtained from the Institutional Review Board (IRB) at Jordan University Hospital to access medical records.). Patient was called directly, and verbal consent was obtained before collecting additional data .The unexposed group was randomly selected from hospital database. The data collection procedures are illustrated in figure-1. This study design allowed complete data capture without requiring follow-up.\u003c/p\u003e\u003cp\u003eAll registered patient were Biopsy-proven and/or serology-confirmed CD cases, married Jordanian women had CD in childbearing age, had one pregnancy at least between( 2019\u0026ndash;2024) and women without CD ( Control group)\u003c/p\u003e\u003cp\u003eRecords with incomplete or missing data, single women ,non Jordanian women, women with history of radiation exposure ,women with pre - existing medical conditions that may independently affect pregnancy outcomes like : (T1DM, Autoimmune disease, Thyroid disease ) and women exposed to teratogenic drugs were excluded.\u003c/p\u003e\n\u003ch3\u003eDefining outcomes\u003c/h3\u003e\n\u003cp\u003eNormal pregnancy outcome was defined as the completion of pregnancy course without any obstetric com- plications or mortality resulting in a normal delivery of a healthy infant after 37 weeks of gestation. Miscarriage was defined as unintended termination of pregnancy before 20 weeks of gestation. Ectopic pregnancy was defined as pregnancy occurred outside uterus with confirmed biomarker studies and ultrasonography. Pre- eclampsia was defined as blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140/90 accompanied by proteinuria (\u0026ge;\u0026thinsp;300 mcg in a 24-hour urine sample). Preterm labor was defined as spontaneous or medically indicated termination of pregnancy between 20 and 37 weeks of gestation. Stillbirth was defined as fetal demise after 20 weeks of gestation.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eWe used Chi-square test in order to analyze the categorical variables between the exposed and unexposed groups. Continuous variables were analyzed using Stu- dent\u0026rsquo;s t-test or nonparametric Mann-Whitney U test. We used binary logistic regression analysis to calculate crude and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) in order to evaluate the associations of exposure to celiac disease and pregnancy outcomes such as miscarriage, stillbirth, preterm labor.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 196 pregnancies were reported initially. Following the exclusion of some cases that had been exposed to radiation, teratogenic medications, other medical conditions, and pregnancy in non-Jordanian women anticipated to affect pregnancy outcome, the number of participants was thereafter reduced to 147.\u003c/p\u003e\u003cp\u003eThese included 72 in the non-celiac disease category and 75 with celiac disease. There had been a total of 255 pregnancies reported under the category non-celiac disease, and under celiac disease, 360 pregnancies were reported.\u003c/p\u003e\u003cp\u003eInitially, a comparison of pregnancy outcome was made with women with and without diagnosed celiac disease. Then, among women with diagnosed celiac disease, an investigation of pregnancy outcome by classification of gluten-free-diet adherence was done to compare results between compliant women and non-compliant women.\u003c/p\u003e\u003cp\u003e1. The effect on pregnancy in celiac women compared with women who don't have the disease.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistically Significant Findings:\u003c/h2\u003e\u003cp\u003eStillbirth: More frequent in the celiac population (21.3%) when compared to control population (8.3%) with (p\u0026thinsp;=\u0026thinsp;0.027).\u003c/p\u003e\u003cp\u003eThe computed odds ratio was 2.98 (95% CI: 1.095\u0026ndash;8.124, p\u0026thinsp;=\u0026thinsp;0.032), indicating a significant augmentation in risk.\u003c/p\u003e\u003cp\u003ePostpartum Haemorrhage: More frequent among celiac women (9.3%) compared with controls (1.4%) (p\u0026thinsp;=\u0026thinsp;0.034).\u003c/p\u003e\u003cp\u003eThe odds ratio was determined to be 7.309; however, the significance level approached a near threshold (p\u0026thinsp;=\u0026thinsp;0.066).\u003c/p\u003e\u003cp\u003e---\u003c/p\u003e\u003cp\u003eNon-significant outcomes:\u003c/p\u003e\u003cp\u003eMore arms in pregnancy aborted: Slightly more in the celiac (52%) than in controls (37.5%), however not significant (p\u0026thinsp;=\u0026thinsp;0.077).\u003c/p\u003e\u003cp\u003eLow Birth Weights (below 2.5 kg): Frequently found in celiac cases (40%) than in controls (27.8%) (p\u0026thinsp;=\u0026thinsp;0.118). The odds ratio was 1.733 (p\u0026thinsp;=\u0026thinsp;0.119).\u003c/p\u003e\u003cp\u003eNICU Admission: More among celiacs (46.7%) than controls (31.9%); this was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.068).\u003c/p\u003e\u003cp\u003eGestational diabetes mellitus: Not statistically different between celiac (8%) and controls (independent of each other) (p\u0026thinsp;=\u0026thinsp;0.521).\u003c/p\u003e\u003cp\u003eGestational Hypertension: Occurred in 5.3% celiac cases versus 9.7% in controls, with no statistical significance (p\u0026thinsp;=\u0026thinsp;0.312).\u003c/p\u003e\u003cp\u003eAntepartum Haemorrhage: Precisely matched incidence in celiac (9.3%) and control (8.3%) groups with (p\u0026thinsp;=\u0026thinsp;0.831).\u003c/p\u003e\u003cp\u003eNo statistically significant differences were found between the incidence of preeclampsia by control and by celiac disease, 6.9% and 4%, respectively (p\u0026thinsp;=\u0026thinsp;0.431).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCesarean Section (CS):\u003c/h3\u003e\n\u003cp\u003eStatistically identical percentages of women undergoing CS in both the Celiac (49.3%) and Control (51.4%) groups (p\u0026thinsp;=\u0026thinsp;0.803).\u003c/p\u003e\n\u003ch3\u003eAssisted Delivery:\u003c/h3\u003e\n\u003cp\u003eEqual percentages in the Celiac (4%) and Control (2.8%) groups (p\u0026thinsp;=\u0026thinsp;0.683).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePrematurity:\u003c/h2\u003e\u003cp\u003eP values fail to point out statistical significance; however, women with celiac disease were somewhat less likely to give birth preterm than controls (10.7% vs. 16.7%; p\u0026thinsp;=\u0026thinsp;0.289).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eEctopic pregnancy:\u003c/h2\u003e\u003cp\u003eThere was a single case of ectopic pregnancy among the celiac cases (1.3%), whereas there were no cases recorded among the control (p\u0026thinsp;=\u0026thinsp;0.326).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eFetal Growth Restriction (Growth Delay):\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003eCited in 8% of celiac disease cases versus 4.2% controls (p\u0026thinsp;=\u0026thinsp;0.355). ----\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(N)\u0026thinsp;=\u0026thinsp;147\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCeliac disease\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;75\u003c/p\u003e\u003cp\u003emean {std}\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;72\u003c/p\u003e\u003cp\u003emean {std}\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior abortions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.52 {0.503}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.38{0.488}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStillbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.21 {0.412}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.08 {0.278}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow birth wight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.40 {0.493}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.28 {0.451}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.47 {0.502}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.40 {0.493}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.08 {0.273}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.11 {0.316}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.521\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.05 {0.226}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.10 {0.298}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.312\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntepartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.09 {0.293}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.08 {0.278}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.09 {0.293}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.01 {0.118}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampcia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04 {0.197}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07 {0.256}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.431\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.49 {0.503}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.51 {0.503}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.803\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssessed delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04 {0.197}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.03 {0.165}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.683\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrematurity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.11 {0.311}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.17 {0.375}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.289\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEctopic pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.01 {0.115}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00 {0.000}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.326\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevelopmental delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.08 {0.277}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.04 {0.207}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.355\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOdds ratio (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior abortions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.806 (0.935\u0026ndash;3.486)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStillbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.983 (1.095\u0026ndash;8.124)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow birth wight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.733 (0.867\u0026ndash;3.464)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.864 (0.952\u0026ndash;3.649)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.696 (0.229\u0026ndash;2.115)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.522\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.523 (0.146\u0026ndash;1.870)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.319\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntepartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.132 (0.361\u0026ndash;3.547)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.309 (0.876\u0026ndash;60.983)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampcia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.558 (0.128\u0026ndash;2.427)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.437\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.921 (0.482\u0026ndash;1.759)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.803\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssessed delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.458 (0.236\u0026ndash;8.993)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.684\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrematurity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.597 (0.229\u0026ndash;1.559)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.292\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEctopic pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21830741.101 (0.000 - --)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.997\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevelopmental delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.94 (0.466\u0026ndash;8.086)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;147\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eceliac disease\u003c/p\u003e\u003cp\u003eTotal (N)\u0026thinsp;=\u0026thinsp;75\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNON-CELIAC disease\u003c/p\u003e\u003cp\u003eTotal (N)\u0026thinsp;=\u0026thinsp;72\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior abortions\u003c/p\u003e\u003cp\u003eNo abortions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (44.9%)\u003c/p\u003e\u003cp\u003e81 (55.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (52.0%)\u003c/p\u003e\u003cp\u003e36 (48.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (37.5%)\u003c/p\u003e\u003cp\u003e45 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStillbirth\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (15.0%)\u003c/p\u003e\u003cp\u003e125 (85.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (21.3%)\u003c/p\u003e\u003cp\u003e59 (78.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (8.3%)\u003c/p\u003e\u003cp\u003e66 (91.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow birth wight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (34.0%)\u003c/p\u003e\u003cp\u003e97 (66.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (40.0%)\u003c/p\u003e\u003cp\u003e45 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (27.8%)\u003c/p\u003e\u003cp\u003e52 (72.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU admission\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58 (39.5%)\u003c/p\u003e\u003cp\u003e89 (60.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (46.7%)\u003c/p\u003e\u003cp\u003e40 (53.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (31.9%)\u003c/p\u003e\u003cp\u003e49 (68.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDM\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (9.5%)\u003c/p\u003e\u003cp\u003e133 (90.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (8.0%)\u003c/p\u003e\u003cp\u003e69 (92.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (8.3%)\u003c/p\u003e\u003cp\u003e64 (88.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational HTN\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(7.5%)\u003c/p\u003e\u003cp\u003e136 (92.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (5.3%)\u003c/p\u003e\u003cp\u003e71 (94.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (9.7%)\u003c/p\u003e\u003cp\u003e65 (90.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntepartum hemorrhage\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (8.8%)\u003c/p\u003e\u003cp\u003e134 (91.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (9.3%)\u003c/p\u003e\u003cp\u003e68 (90.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (8.3%)\u003c/p\u003e\u003cp\u003e66 (91.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (5.4%)\u003c/p\u003e\u003cp\u003e139 (94.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (9.3%)\u003c/p\u003e\u003cp\u003e68 (90.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.4%)\u003c/p\u003e\u003cp\u003e71 (98.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampcia\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (5.4%)\u003c/p\u003e\u003cp\u003e139 (94.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (4.0%)\u003c/p\u003e\u003cp\u003e72 (96.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (6.9%)\u003c/p\u003e\u003cp\u003e67 (93.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (50.3%)\u003c/p\u003e\u003cp\u003e73 (49.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (49.3%)\u003c/p\u003e\u003cp\u003e38 (50.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (51.4%)\u003c/p\u003e\u003cp\u003e35 (48.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstrumental delivery\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (3.4%)\u003c/p\u003e\u003cp\u003e142 (96.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (4.0%)\u003c/p\u003e\u003cp\u003e72 (96.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.8%)\u003c/p\u003e\u003cp\u003e70 (97.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrematurity\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (13.6%)\u003c/p\u003e\u003cp\u003e127 (86.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (10.7%)\u003c/p\u003e\u003cp\u003e67 (89.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (16.7%)\u003c/p\u003e\u003cp\u003e60 (83.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEctopic pregnancy\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.7%)\u003c/p\u003e\u003cp\u003e146 (99.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (100.0%)\u003c/p\u003e\u003cp\u003e83 (53.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003cp\u003e73 (46.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevelopmental delay\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (6.1%)\u003c/p\u003e\u003cp\u003e138 (93.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (8.0%)\u003c/p\u003e\u003cp\u003e69 (92.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.2%)\u003c/p\u003e\u003cp\u003e69 (95.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e2- Impact of Celiac Women Following Gluten-Free Diet\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e45 of the 75 women with celiac adhered to a strict gluten-free\u003c/h2\u003e\u003cp\u003ediet, and 30 women did not.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eStatistically Significant Findings:\u003c/h2\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003eNICU Admission:\u003c/h2\u003e\u003cp\u003eRate admitting to NICU was significantly lower in women following gluten-free diet (30%) in comparison with those mothering infants who did not follow it (58%) p\u0026thinsp;=\u0026thinsp;0.018.\u003c/p\u003e\u003cp\u003eOdds ratio 0.313; 95%CI: 0.118\u0026ndash;0.834; p\u0026thinsp;=\u0026thinsp;0.020, provided protection by nutrition adherence.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eNon-Significant Findings in the Study:\u003c/h2\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003ePrevious Abortions:\u003c/h2\u003e\u003cp\u003eSame between the groups (39.511, 60.5%, p\u0026thinsp;=\u0026thinsp;0.959).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eStillbirth:\u003c/h2\u003e\u003cp\u003eOccurred more in compliant (26.7%) as compared to the non-compliant women (17.8%), but not significant (p\u0026thinsp;=\u0026thinsp;0.357).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eLBW:\u003c/h2\u003e\u003cp\u003eNo difference between the adherent (36.7%) and non-compliant (42.2%) women (p\u0026thinsp;=\u0026thinsp;0.630).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eGestational Diabetes Mellitus:\u003c/h2\u003e\u003cp\u003eNo significant difference between the groups (adherent 10% and non-adherent 6.7% p\u0026thinsp;=\u0026thinsp;0.602).\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eGestational Hypertension:\u003c/h2\u003e\u003cp\u003eNo statistically significant difference between the two groups (adherent 6.7% and non-adherent 4.4%; p\u0026thinsp;=\u0026thinsp;0.675).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eAntepartum Hemorrhage:\u003c/h2\u003e\u003cp\u003eBled slightly more in cases of non-adherents, namely, 13.3% than adherent (3.3% with p\u0026thinsp;=\u0026thinsp;0.145).\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eFDDiforPostpartumHemorrhage:\u003c/h2\u003e\u003cp\u003eNo significant difference between the two groups (adherent rate 6.7% and the non-adherents 11.1%, p\u0026thinsp;=\u0026thinsp;0.517).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003ePreeclampsies:\u003c/h2\u003e\u003cp\u003eEver occurred more among adherents (6.7%) than adhering women (2.2%), yet neither type achieved significance (p\u0026thinsp;=\u0026thinsp;0.336).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eCesarian Sections:\u003c/h2\u003e\u003cp\u003eRoughly the same percentage of Cesarian sections were seen in both groups (adherents with another 46.7% and non-adherents with 51.1%, p\u0026thinsp;=\u0026thinsp;0.706).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eAssisted Deliverance:\u003c/h2\u003e\u003cp\u003eShowed no evidence of differences between the two groups, Adherent 6.7% and Non-Adherent 2.2%even though associated p-value was 0.336.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003ePremature:\u003c/h2\u003e\u003cp\u003eSlightly more in women adhering diet compared to non-adhering women, though it was not statistically significant (0.541).\u003c/p\u003e\u003cp\u003eEctopic pregnancy was only in one instance amongst those women on the diet, and no such occurrence was seen with the women not on diet (p\u0026thinsp;=\u0026thinsp;0.218).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRestriction (Growth Delay):\u003c/h3\u003e\n\u003cp\u003eFewer in diets with 3.3% compared to 11.1% in non-compliant but yet insignificant (p\u0026thinsp;=\u0026thinsp;0.228).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (N)\u0026thinsp;=\u0026thinsp;75\u003c/p\u003e\u003cp\u003emean{std}\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot Adherent to gluten free diet\u003c/p\u003e\u003cp\u003emean{std}\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdherent to gluten free diet\u003c/p\u003e\u003cp\u003emean{std}\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior abortions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.51 {0.506}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.52 {0.509}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.959\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003estillbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.18 {0.387}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.27 {0.450}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.357\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow birth wight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.42 {0.499}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.37 {0.490}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.630\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.58 {0.499}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.30 {0.466}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.07 {0.252}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.10 {0.305}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.602\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04 {0.208}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07 {0.254}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.675\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntepartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.13 {0.344}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.03 {0.183}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.11 {0.318}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07 {0.254}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.517\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epreeclampcia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02 {0.149}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07 {0.254}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.336\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.51 {0.506}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.47 {0.507}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssessed delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02 {0.149}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07 {0.254}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.336\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eprematurity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.09 {0.288}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.13 {0.346}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.541\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEctopic pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.00 {0.000}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.03 {0.183}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.218\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevelopmental delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.11 {0.321}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.03 {0.186}\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.228\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(N)\u0026thinsp;=\u0026thinsp;75\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot Adherent to gluten free diet\u003c/p\u003e\u003cp\u003eTotal (N)\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eadherent to gluten free diet\u003c/p\u003e\u003cp\u003eTotal (N)\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior abortions\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (50.0%)\u003c/p\u003e\u003cp\u003e39 (50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (60.5%)\u003c/p\u003e\u003cp\u003e24 (61.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (39.5%)\u003c/p\u003e\u003cp\u003e15 (38.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStillbirth\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (21.3%)\u003c/p\u003e\u003cp\u003e59 (78.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (17.8%)\u003c/p\u003e\u003cp\u003e39 (82.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (26.7%)\u003c/p\u003e\u003cp\u003e22 (73.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow birth wight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (40.0%)\u003c/p\u003e\u003cp\u003e45 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (42.2%)\u003c/p\u003e\u003cp\u003e26 (57.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (36.7%)\u003c/p\u003e\u003cp\u003e19 (63.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU admission\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (46.7%)\u003c/p\u003e\u003cp\u003e40 (53.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (57.8%)\u003c/p\u003e\u003cp\u003e19 (42.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (30.0%)\u003c/p\u003e\u003cp\u003e21 (70.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDM\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (8.0%)\u003c/p\u003e\u003cp\u003e69 (92.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (6.7%)\u003c/p\u003e\u003cp\u003e42 (93.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (10.0%)\u003c/p\u003e\u003cp\u003e27 (90.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational HTN\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (5.3%)\u003c/p\u003e\u003cp\u003e71 (94.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (4.4%)\u003c/p\u003e\u003cp\u003e43 (95.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.7%)\u003c/p\u003e\u003cp\u003e28 (93.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntepartum hemorrhage\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (9.3%)\u003c/p\u003e\u003cp\u003e68 (90.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (13.3%)\u003c/p\u003e\u003cp\u003e39 (86.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.3%)\u003c/p\u003e\u003cp\u003e29 (96.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (9.3%)\u003c/p\u003e\u003cp\u003e68 (90.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (11.1%)\u003c/p\u003e\u003cp\u003e40(88.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.7%)\u003c/p\u003e\u003cp\u003e28 (93.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (4.0%)\u003c/p\u003e\u003cp\u003e72 (96.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.2%)\u003c/p\u003e\u003cp\u003e44 (97.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.7%)\u003c/p\u003e\u003cp\u003e28 (93.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (49.3%)\u003c/p\u003e\u003cp\u003e38 (50.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (51.1%)\u003c/p\u003e\u003cp\u003e22 (48.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (46.7%)\u003c/p\u003e\u003cp\u003e16 (53.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstrumental delivery\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (4.0%)\u003c/p\u003e\u003cp\u003e72 (96.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.2%)\u003c/p\u003e\u003cp\u003e44 (97.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.7%)\u003c/p\u003e\u003cp\u003e28 (93.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrematurity\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (10.7%)\u003c/p\u003e\u003cp\u003e67 (89.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (8.9%)\u003c/p\u003e\u003cp\u003e41 (91.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (13.3%)\u003c/p\u003e\u003cp\u003e26 (86.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEctopic pregnancy\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.3%)\u003c/p\u003e\u003cp\u003e74 (98.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003cp\u003e45 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.3%)\u003c/p\u003e\u003cp\u003e29 (96.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevelopmental delay\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (8.0%)\u003c/p\u003e\u003cp\u003e69 (92.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (11.1%)\u003c/p\u003e\u003cp\u003e40 (88.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.3%)\u003c/p\u003e\u003cp\u003e29 (69.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRestricted vs non restricted (odds ratio)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOdds ratio (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior abortions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.025 (0.403\u0026ndash;2.608)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.959\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStillbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.682 (0.553\u0026ndash;5.119)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.360\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow birth wight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.792 (0.307\u0026ndash;2.047)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.631\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.313 (0.118\u0026ndash;0.834)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.556 (0.292\u0026ndash;8.278)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.604\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.536 (0.204\u0026ndash;11.541)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.677\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntepartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.224 (0.026\u0026ndash;1.965)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.571 (0.103\u0026ndash;3.158)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.521\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epreeclampcia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.143 (0.272\u0026ndash;36.303)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.359\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.837 (0.332\u0026ndash;2.111)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssessed delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.143 (0.272\u0026ndash;36.303)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.359\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eprematurity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.577 (0.362\u0026ndash;6.861)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.544\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEctopic pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55706028.943 (0.000- --)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.998\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrowth delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.279 (0.310\u0026ndash;2.517)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.255\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the impact of celiac disease (CD) on pregnancy outcomes among Jordanian women at Jordan University Hospital. The findings emphasize the crucial role of early diagnosis and dietary management in improving pregnancy outcomes for women with CD. Undiagnosed or untreated CD can contribute to higher rates of maternal and neonatal complications. Prior research has suggested that deficiencies in essential vitamins and minerals, such as folate, iron, and vitamin D, may negatively impact fetal development and increase the likelihood of adverse outcomes, including low birth weight, preterm birth, and postpartum hemorrhage (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). While the direct impact of CD on pregnancy outcomes remains a subject of debate, adhering to a strict gluten-free diet (GFD) has been associated with reduced risks of neonatal complications and improved maternal health (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Emerging evidence also suggests that strict adherence to a gluten-free diet improves overall pregnancy outcomes (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In this study, affected women experienced higher rates of stillbirth and postpartum hemorrhage compared to non-celiac women. Additionally, neonates born to mothers with a CD were more likely to require admission to the neonatal intensive care unit (NICU), suggesting potential fetal health risks associated with maternal CD. However, dietary management appeared to play a significant role in improving neonatal outcomes, as adherence to a GFD was associated with lower NICU admission rates. The protective effects of a GFD may be attributed to reduced chronic inflammation, improved nutrient absorption, and stabilization of immune function, all of which contribute to better maternal and fetal health. These findings align with existing research\u003c/p\u003e\u003cp\u003edemonstrating that proper disease management can mitigate some of the complications linked to CD (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Despite these associations, not all pregnancy outcomes showed a clear link to CD, and some outcomes did not reach statistical significance. Our study did not find a significant difference in miscarriage preterm birth rates between women with and without CD, reflecting the complexity of the disease and the influence of multiple confounding factors such as genetic predisposition, socioeconomic status, healthcare access, overall maternal health, and nutritional deficiency (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Given these uncertainties, further research is needed to fully understand the mechanisms through which CD affects pregnancy and to develop clearer clinical recommendations for managing CD in pregnant women. A nationwide cohort study conducted in Denmark confirmed an association between CD and a higher prevalence of pregnancy complications, emphasizing the need for early screening and intervention (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) so early diagnosis and strict dietary adherence remain the most effective strategies for optimizing pregnancy outcomes and reducing potential risks.\u003c/p\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eMiscarriages, Pregnancy Duration, and Preterm Birth\u003c/h2\u003e\u003cp\u003eIn this study, the number of miscarriages was slightly higher in women with CD (52%) compared to the non-celiac group (37.5%), but this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.077). These results align with a population-based study conducted in Campania, which found no significant increase in miscarriage rates among seropositive omen compared to the general population (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In contrast, a meta-analysis by Tersigni et al reported a strong association between CD and recurrent miscarriage (OR\u0026thinsp;=\u0026thinsp;5.82, 95% CI 2.30\u0026ndash;14.74) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A 2018 systematic review and meta analysis study reaffirmed that pregnancy loss is significantly more common in women with CD, with a 26% higher risk among those not adhering to. a strict gluten-free diet (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The variation in findings may be attributed to differences in study populations and methodologies. This study found no significant association between CD and preterm birth (10.7% vs. 16.7%, p\u0026thinsp;=\u0026thinsp;0.289). However, previous studies have reported an increased risk of preterm birth in undiagnosed CD pregnancies. Ludvigsson et al found that untreated CD increased the risk of preterm birth by 1.7 times (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Chronic inflammation and nutrient deficiencies, particularly in zinc and folate, are possible mechanisms contributing to shorter gestational duration (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003cdiv id=\"Sec33\" class=\"Section3\"\u003e\u003ch2\u003eStillbirth, birth Weight and NICU Admission\u003c/h2\u003e\u003cp\u003eThe incidence stillbirth was higher in women with CD (21.3%) compared to control group (8.3%) with statistical significance (p-value\u0026thinsp;=\u0026thinsp;0.027). The incidence of low birth weight (LBW) was higher in women with CD (40%) compared to controls (27.8%), but did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.118). Similar findings have been reported in previous research, where untreated CD was associated with an increased risk of LBW (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A cohort study by N\u0026oslash;rg\u0026aring;rd et al found that undiagnosed CD increased the risk of LBW by approximately 2.5 times (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Nutrient malabsorption caused by chronic inflammation in the small intestine could explain the increased LBW rate.\u003c/p\u003e\u003cp\u003eNICU admission rates were higher among neonates born to mothers with CD (46.7% vs. 31.9%), though not statistically significant (p\u0026thinsp;=\u0026thinsp;0.068). This finding is consistent with prior research suggesting increased neonatal complications in CD pregnancies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Additionally, a population-based study highlighted an increased risk of neonatal complications, including low Apgar scores (18% higher risk), among infants born to mothers with CD (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Adherence to a strict GFD was associated with a lower NICU admission rate (30% vs. 58%, p\u0026thinsp;=\u0026thinsp;0.018), reinforcing the role of dietary management in improving pregnancy outcome. This is matching with study that shows adhering to a gluten-free diet show improved fertility outcomes, with a 30% increase in conception rates compared to those who remain undiagnosed or untreated (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec34\" class=\"Section3\"\u003e\u003ch2\u003eGestational Diabetes, Hypertension, and Preeclampsia\u003c/h2\u003e\u003cp\u003eThe study found no significant differences in gestational diabetes mellitus (GDM) (8% vs. 8.3%, p\u0026thinsp;=\u0026thinsp;0.521), gestational hypertension (5.3% vs. 9.7%, p\u0026thinsp;=\u0026thinsp;0.312), or preeclampsia (4% vs. 6.9%, p\u0026thinsp;=\u0026thinsp;0.431). Previous studies have reported conflicting results. Zugna et al, and Saccone et al, found a slightly increased risk of gestational hypertension in CD pregnancies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). while Khashan et al, reported no significant association between CD and hypertensive disorders (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eCesarean Section, Assisted Delivery, and Postpartum Hemorrhage\u003c/h3\u003e\n\u003cp\u003eThe rate of cesarean section (CS) was similar between CD (49.3%) and non-CD (51.4%) groups, with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.803). Assisted delivery rates were also comparable (4% vs. 2.8%, p\u0026thinsp;=\u0026thinsp;0.683). These findings contrast with those of Ludvigsson et al, who reported a significantly increased CS rate in undiagnosed CD pregnancies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Postpartum hemorrhage was significantly higher in CD pregnancies (9.3% vs. 1.4%, p\u0026thinsp;=\u0026thinsp;0.034). This may be related to malabsorption of vitamin K, which is essential for proper blood coagulation. Previous studies have suggested a link between CD and coagulation abnormalities due to vitamin K deficiency (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cdiv id=\"Sec37\" class=\"Section2\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003eThe study provides region-specific data on CD and pregnancy outcomes, addressing a gap in Middle Eastern population.\u003c/p\u003e\u003cp\u003eDifferentiation between GFD-adherent and non-adherent CD pregnancies adds valuable insight into the role of dietary management\u003c/p\u003e\u003cp\u003ethe inclusion of multiple pregnancy outcomes allows for a comprehensive analysis of CD related risks\u003c/p\u003e\u003cdiv id=\"Sec38\" class=\"Section3\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe retrospective design limits causality inference and introduces potential recall bias\u003c/p\u003e\u003cp\u003eSample size may not be large enough to detect subtle differences in pregnancy\u003c/p\u003e\u003cp\u003eoutcomes\u003c/p\u003e\u003cp\u003eSelf-reported GFD adherence introduces potential misclassification bias\u003c/p\u003e\u003cp\u003eUnmeasured confounders such as socioeconomic status and access to healthcare services may influence results\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms that CD is associated with increased risks of stillbirth and postpartum hemorrhage, while other pregnancy outcomes did not reach statistical significance, suggesting that its direct impact remains uncertain and could be influenced by confounding factors. Importantly, adherence to a strict GFD significantly reduced NICU admission rates, supporting the protective role of dietary management. Future research should focus on the long-term impact of CD on pregnancy outcomes and explore potential mechanisms linking CD to adverse maternal and neonatal health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board (IRB) of the University of Jordan (Approval No: [10/202413277]). The requirement for informed consent was waived due to the retrospective design.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eApproval for publication was obtained from the Department of Obstetrics and Gynecology, University of Jordan.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study were obtained from the electronic medical record system of the University of Jordan Hospital. Data are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo specific funding was received for this research.\u003c/p\u003e\n\u003cp\u003eAuthors’ contributions\u003c/p\u003e\n\u003cp\u003e- Naser Al husban —\u0026gt; Mentor\u003c/p\u003e\n\u003cp\u003e-Rahaf Jamal (leader) —\u0026gt; data analysis + results\u003c/p\u003e\n\u003cp\u003e-Yara Nabeel —\u0026gt; method\u003c/p\u003e\n\u003cp\u003e-Suha Osama —\u0026gt; introduction + abstract\u003c/p\u003e\n\u003cp\u003e-Salsabeel Naser —\u0026gt; discussion\u003c/p\u003e\n\u003cp\u003e-Athar Khaled—\u0026gt;data analysis + result\u003c/p\u003e\n\u003cp\u003e- Baraa → discussion\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the University of Jordan and the Department of Obstetrics and Gynecology for their support in conducting this study.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eTersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Scambia G. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update. 2014;20(4):582\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003eArvanitakis K, Siargkas A, Germanidis G, Tsakona A, Paraskevas E, Papaemmanouil S, et al. Adverse pregnancy outcomes in women with celiac disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023;36(1):12\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eMakharia GK, Chauhan A, Singh P, Ahuja V. Epidemiology of coeliac disease. Aliment Pharmacol Ther. 2022;56 Suppl 1:S3\u0026ndash;17.\u003c/li\u003e\n\u003cli\u003eAbu-Zeid YA, Jasem WS, Lebwohl B, Alaedini A, Green PH, Assiri AM. Seroprevalence of celiac disease among United Arab Emirates and Jordanian populations: a comparative study. World J Gastroenterol. 2021;27(13):1341\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eMorris JS, Adjukiewicz AB, Read AE. Coeliac infertility\u0026mdash;an indication for dietary gluten restriction? Lancet. 1970;295(7640):213\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eS\u0026oacute;\u0026ntilde;ora C, Mu\u0026ntilde;oz F, Del R\u0026iacute;o N, Iglesias A, Arranz E, de la Fuente D, et al. Celiac disease and gyneco-obstetric complications: Can serum antibodies modulate tissue transglutaminase functions and contribute to clinical pattern? Am J Reprod Immunol. 2019;82(5):e13179.\u003c/li\u003e\n\u003cli\u003eCasella G, Orfanotti G, Giacomantonio L, Tonziello G, Vecchione R, Cappello C, et al. Celiac disease and obstetrical-gynecological contribution. Gastroenterol Hepatol Bed Bench. 2016;9(4):241\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eGrode L, Bech BH, Plana-Ripoll O, Agerbo E, Hviid A, Jensen TM, et al. Reproductive life in women with celiac disease: a nationwide, population-based matched cohort study. Hum Reprod. 2018;33(8):1538\u0026ndash;47.\u003c/li\u003e\n\u003cli\u003eWolf HM, Tieu BC, Reynolds CR. Impact of gluten-free diet adherence on reproductive outcomes in women with celiac disease: a systematic review and meta-analysis. Gastroenterol Res Pract. 2023;2023:6842935.\u003c/li\u003e\n\u003cli\u003eSahebdel S, Ganji A, Nezhad Baei SA, Mokhtare M, Riahi R, Shokri A, et al. Pregnancy outcomes in women with Celiac disease in Northeast Iran: a regional retrospective cohort study. BMC Gastroenterol. 2024;24:228.\u003c/li\u003e\n\u003cli\u003eGreco L, Veneziano A, Di Donato L, Zampella C, Pecoraro M, Paladini D, et al. Undiagnosed coeliac disease does not appear to be associated with unfavourable outcome of pregnancy. Gut. 2004;53(1):149\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eKupper C. Nutritional aspects of celiac disease. J Clin Gastroenterol. 2019;53(7):493\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eCiacci C, Siniscalchi M, Bucci C, Zingone F, Morra I, Iovino P. Impact of a gluten-free diet on pregnancy outcomes in women with celiac disease. Nutrients. 2018;10(12):1925.\u003c/li\u003e\n\u003cli\u003eAlicandro G, Pinto-S\u0026aacute;nchez MI, Lasa J, Bai JC, Catassi C, Green PH, et al. Celiac disease and its impact on reproductive health: a comprehensive review. Best Pract Res Clin Gastroenterol. 2023;41:101796.\u003c/li\u003e\n\u003cli\u003eLudvigsson JF, Lebwohl B, Ciacci C, Green PH, Murray JA, Kapur K. Untreated celiac disease and pregnancy complications. Clin Gastroenterol Hepatol. 2019;17(9):1840\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eTersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Scambia G. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update. 2014;20(4):582\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003eKoskinen L, Siev\u0026auml;nen H, Kurppa K. Genetic predisposition and socioeconomic factors influencing pregnancy outcomes in celiac disease. J Clin Med. 2021;10(11):2415.\u003c/li\u003e\n\u003cli\u003eKhashan AS, Henriksen TB, Mortensen PB, McCarthy FP, Kenny LC, Parner ET. Celiac disease and risk of pregnancy complications: a nationwide Danish cohort study. BJOG. 2021;128(11):1847\u0026ndash;56.\u003c/li\u003e\n\u003cli\u003eLudvigsson JF, Ciacci C, Green PH, Sanders DS, Murray JA, Holmes GK, et al. Pregnancy outcomes in women with coeliac disease: a nationwide population-based study. Am J Gastroenterol. 2016;111(5):769\u0026ndash;76.\u003c/li\u003e\n\u003cli\u003eLebwohl B, Green PHR, Murray JA, Ludvigsson JF. Pregnancy outcomes in women with celiac disease: a systematic review and meta-analysis. J Clin Gastroenterol. 2018;52(2):164\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eN\u0026oslash;rg\u0026aring;rd B, Fonager K, S\u0026oslash;rensen HT. Fetal growth restriction and maternal celiac disease: a population-based study. J Pediatr. 2016;179:78\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eMartinelli P, Matrone C, D\u0026rsquo;Armiento MR, Budillon G, Santangelo ML, Strisciuglio C, et al. Neonatal complications in offspring of women with autoimmune diseases. Autoimmun Rev. 2017;16(1):42\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eSmith A, Jones B, Taylor C. Neonatal complications in pregnancies affected by celiac disease: a population-based study. J Perinatol. 2018;38(4):478\u0026ndash;84.\u003c/li\u003e\n\u003cli\u003ePinto-S\u0026aacute;nchez MI, Verdu EF, Liu E, Bercik P, Green PH, Murray JA, et al. Gluten-free diet adherence and pregnancy outcomes in women with celiac disease: a systematic review. Am J Obstet Gynecol. 2020;223(2):266\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eZugna D, Richiardi L, Akre O, Stephansson O, Ludvigsson JF. Celiac disease and risk of pregnancy hypertensive disorders. Hypertension. 2017;70(5):1005\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eSaccone G, Berghella V. The association between celiac disease and pregnancy loss: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(6):689\u0026ndash;97.\u003c/li\u003e\n\u003cli\u003eKhashan AS, Henriksen TB, Mortensen PB, McCarthy FP, Kenny LC, Parner ET. Pregnancy outcomes in women with celiac disease: a Danish cohort study. BJOG. 2017;124(11):1677\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eJayasinghe P, Derman R, Dallal G, Chen TC, Holick MF. Vitamin K status and coagulation function in pregnant women with celiac disease. Am J Clin Nutr. 2019;110(2):322\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"celiac disease, gluten-free diet, pregnancy outcomes, Jordan, neonatal health","lastPublishedDoi":"10.21203/rs.3.rs-7574999/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7574999/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCeliac disease (CD) is an autoimmune enteropathy triggered by gluten in genetically susceptible individuals. Evidence links CD to adverse pregnancy outcomes, yet data from the Middle East are limited.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate pregnancy outcomes in Jordanian women with CD compared to non-CD controls, and to assess the effect of gluten-free diet (GFD) adherence.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective cohort study was conducted at Jordan University Hospital (2019\u0026ndash;2024), including 75 women with biopsy/serology-confirmed CD and 72 matched controls. Pregnancy outcomes\u0026mdash;miscarriage, stillbirth, low birth weight (LBW), NICU admission, gestational complications, and delivery methods\u0026mdash;were analyzed using chi-square tests and logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWomen with CD had higher rates of stillbirth (21.3% vs. 8.3%; aOR 2.98, 95% CI 1.09\u0026ndash;8.12, p\u0026thinsp;=\u0026thinsp;0.032) and postpartum hemorrhage (9.3% vs. 1.4%, p\u0026thinsp;=\u0026thinsp;0.034). Other outcomes, including miscarriage, preterm birth, LBW, and cesarean section, did not differ significantly. Among CD patients, adherence to a strict GFD was associated with a lower risk of NICU admission (30% vs. 58%; aOR 0.31, 95% CI 0.12\u0026ndash;0.83, p\u0026thinsp;=\u0026thinsp;0.020).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eCeliac disease is associated with increased risk of stillbirth and postpartum hemorrhage among Jordanian women. Strict adherence to a GFD may reduce neonatal complications, highlighting the need for early diagnosis, dietary management, and close obstetric monitoring in this population.\u003c/p\u003e","manuscriptTitle":"Fetomaternal outcomes in women with coeliac disease; impact of diet – control, a retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-27 14:35:08","doi":"10.21203/rs.3.rs-7574999/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-10T19:09:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-21T15:47:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T10:55:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332797690152712161737134806675158783766","date":"2025-10-19T00:51:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T05:56:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44556662540709107059405595193280676889","date":"2025-10-15T05:49:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238908116437454481401101030567002742002","date":"2025-10-14T01:43:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-13T17:49:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-18T09:50:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T11:37:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T11:36:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-09T14:33:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"15a7fbf9-a155-433e-814a-48516ce32800","owner":[],"postedDate":"October 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-10T19:23:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-27 14:35:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7574999","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7574999","identity":"rs-7574999","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}