Published on 27th September 2018

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A large observational study published in The BMJ has found that children born to women who eat high levels of gluten during pregnancy may have a higher risk of going on to develop the autoimmune condition type 1 diabetes.¹

The study, carried out by researchers from the Bartholin Institute and the Statens Serum Institut, Denmark, analysed data from 63,529 pregnant women, finding that children born to women who ate high amounts of gluten (20 g/day or more) had double the risk of developing type 1 diabetes compared with those born to women who ate the lowest amount of gluten (less than 7 g/day). Average gluten intake was 13 g/day.

Gluten, which is a general name for the proteins found in wheat, rye, and barley, has been suggested to affect the development of type 1 diabetes. Yet whilst animal studies have found that a gluten-free diet during pregnancy almost completely prevents type 1 diabetes in offspring, to date no such intervention study has been undertaken in pregnant women.

To investigate whether there might be a possible link, the researchers used data from women who had been enrolled into the Danish National Birth Cohort between January 1996 and October 2002. The women had reported their diet using a food frequency questionnaire at week 25 of pregnancy, and information on type 1 diabetes in their children was obtained over a mean follow-up period of 15.6 years through the Danish Registry of Childhood and Adolescent Diabetes.

After taking account of potentially influential factors such as mother’s age, weight (BMI), total energy intake, and smoking during pregnancy, it was found that a child’s risk of type 1 diabetes increased proportionally with the mother’s gluten intake during pregnancy (per 10 g/day increase).

Currently, the reasons for this association are unknown, but it has been suggested that increased inflammation or increased gut permeability (‘leaky’ gut) may be involved. But because this was an observational study, the authors concluded that more evidence was needed before changes to dietary recommendations could be justified. However, they did say that this was a high-quality study with a large sample size, and that they were able to adjust for a number of factors that could have affected the results.

In a linked editorial, researchers at the National Institute for Health and Welfare in Finland, said further studies were needed “to identify whether the proposed association really is driven by gluten, or by something else in the grains or the diet.”²

The authors agreed that it was too early to change dietary recommendations on gluten intake in pregnancy, but said doctors, researchers, and the public “should be aware of the possibility that consuming large amounts of gluten might be associated with an increased risk for the child to develop type 1 diabetes, and that further studies are needed to confirm or rule out these findings, and to explore possible underlying mechanisms”.

 

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References:

1. BMJ 2018;362:k3547 bmj.com/content/362/bmj.k3547
2. BMJ 2018;362:k3867 https://www.bmj.com/content/362/bmj.k3867