What is gluten?
Gluten is a protein found in wheat, barley and rye. It’s what gives bread and other baked goods their stretchy, chewy texture. For most people, eating gluten is not a problem. But for those with celiac disease or non-celiac gluten sensitivity, gluten triggers an immune response that damages the small intestine. This can cause symptoms like diarrhea, bloating, fatigue and nutritional deficiencies.
Is gluten bad during pregnancy?
For women without gluten-related conditions, going gluten-free during pregnancy is generally not recommended. Here’s why:
Gluten-free diets can lack key nutrients
Eliminating gluten means avoiding many fortified and enriched grain products. This can potentially lead to deficiencies in nutrients like iron, folate, niacin, riboflavin and thiamine. Getting adequate amounts of these nutrients is especially important during pregnancy to support fetal growth and development.
May increase gestational diabetes risk
Some research indicates following a gluten-free diet when you don’t need to may raise the risk of developing gestational diabetes. More studies are needed, but it could be related to the differences in nutritional composition of gluten-free foods.
Associated with lower birth weights
One study found that women who reported eating gluten-free for non-medical reasons had a higher likelihood of giving birth to babies with lower birth weights compared to women who consumed gluten. The reason for this association is unclear.
Can be low in fiber
Many gluten-free products are made with refined grains like rice flour or tapioca starch rather than whole grains. This means they can be lower in fiber, an important nutrient that can help relieve pregnancy constipation.
When is a gluten-free diet recommended in pregnancy?
There are certain situations when following a gluten-free diet during pregnancy may be advised:
If you have celiac disease
Having celiac disease means you have a serious autoimmune reaction when eating gluten. It’s crucial for those with celiac to maintain a strict 100% gluten-free diet while pregnant to manage symptoms and avoid complications.
If you have non-celiac gluten sensitivity
For those with NCGS, going gluten-free may also be recommended during pregnancy to alleviate digestive and other symptoms. Speak with your doctor about the best diet to follow.
If you have a wheat allergy
A wheat allergy also requires eliminating gluten. Having a wheat allergy means your immune system overreacts to wheat proteins. This is different from celiac disease and non-celiac gluten sensitivity.
If your baby is at high-risk for celiac disease
Some doctors may suggest going gluten-free during the last trimester of pregnancy and while breastfeeding if your baby is at increased genetic risk for celiac disease, to potentially lower the chances of them developing celiac later on. But the evidence on this is still limited.
Healthy tips for going gluten-free in pregnancy
If you need or decide to go gluten-free while pregnant, be sure to:
Consult with a doctor and registered dietitian
Work with your healthcare team to ensure a gluten-free diet meets your increased nutrient needs in pregnancy. A dietitian can help you plan balanced gluten-free meals.
Focus on naturally gluten-free foods
Base your diet around naturally gluten-free whole foods like fruits, vegetables, lean proteins, dairy, legumes, nuts and gluten-free whole grains like brown rice, quinoa, buckwheat and oats.
Enrich your diet with key nutrients
Eat foods fortified with iron, folic acid, fiber and other important nutrients or consider supplements if advised by your doctor. Getting enough omega-3s from foods like walnuts, chia and flax is also recommended.
Be choosy about gluten-free packaged products
Many processed gluten-free items are made with refined flours and starches and are low in nutrients. Opt for ones made with a blend of whole grains, seeds, legumes and nut flours. Compare nutrition labels and choose those higher in protein, fiber and vitamins/minerals.
Watch your arsenic intake
Rice and rice-based gluten-free products can contain higher levels of arsenic, a toxic heavy metal. Limit rice intake to 2-3 servings per week and vary your gluten-free grains.
Is going gluten-free recommended for breastfeeding?
In general, eliminating gluten from your diet is not necessary simply for breastfeeding. Here’s what to know:
No need to avoid major allergens
Contrary to popular belief, restricting potential allergens like gluten while nursing doesn’t prevent food allergies in breastfed infants, per evidence-based guidelines. Eating a varied diet with top allergens is recommended.
No evidence it improves symptoms in babies
Despite anecdotal claims, research hasn’t shown that a gluten-free diet while breastfeeding reduces fussiness, gas or colic symptoms in babies. Diet changes to treat these issues aren’t typically advised.
May reduce milk supply
There’s some concern that going gluten-free may cause a drop in breast milk production in some cases. This may be related to potential nutritional deficits.
Can provide benefits in special cases
There may be certain situations where breastfeeding gluten-free is suggested, like for infants with celiac disease or if you have celiac and follow a gluten-free diet. It’s best to get personalized advice from your child’s pediatrician.
Foods to eat on a gluten-free diet in pregnancy and while breastfeeding
Focus on getting plenty of these healthy, naturally gluten-free foods in your diet:
Proteins
Eggs, poultry, fish, shellfish, meat, dairy products, legumes, nuts and seeds
Fruits and vegetables
A colorful variety of fresh or frozen fruits and vegetables
Gluten-free whole grains
Brown rice, buckwheat, millet, certified gluten-free oats, quinoa, sorghum
Healthy fats
Avocado, olive oil, coconut oil, flaxseeds, chia seeds, walnuts
| Food group | Recommended servings per day |
|---|---|
| Vegetables | 3-5 |
| Fruits | 2-4 |
| Whole grains and starchy vegetables | 6-11 |
| Protein foods | 3-6 |
| Dairy foods | 2-3 |
Aim for the recommended number of servings from each food group. The amounts are based on general nutrition guidelines for pregnant and breastfeeding women.
Sample one-day gluten-free meal plan
Here is an example of what a one-day gluten-free meal plan may look like during pregnancy and while breastfeeding:
Breakfast
– Gluten-free oatmeal topped with walnuts, chia seeds and fruit
– Scrambled eggs with sautéed peppers and onions
– Glass of milk
Snack
– Apple slices with peanut butter
– Handful of mixed nuts
Lunch
– Tuna salad sandwich on gluten-free bread with lettuce, tomato
– Celery sticks with hummus
– Greek yogurt with blueberries
Snack
– Hardboiled egg
– Slice of gluten-free zucchini bread
Dinner
– Grilled salmon with quinoa and roasted broccoli
– Mixed greens salad with chickpeas and avocado
– Glass of sparkling water
Dessert
– Frozen yogurt with chopped walnuts and cacao nibs
Potential challenges of gluten-free diets in pregnancy and breastfeeding
Transitioning to a gluten-free diet can present some challenges, including:
Higher cost
Many gluten-free products tend to be more expensive than conventional wheat-based foods. The cost of eating gluten-free can add up.
Social restrictions
Avoiding gluten may make dining out, traveling and attending social functions requiring food more difficult. Additional planning and precautions are often needed.
Missing out on nutrients
Gluten-free diets can potentially lack certain vitamins and minerals, especially if heavily reliant on processed foods. Being mindful of nutrition is important.
Difficulty sticking with it
Eliminating major food groups can be challenging to sustain long-term. Working with a dietitian helps ensure you’re meeting needs.
Safety concerns
There is the risk for accidental gluten exposure if foods or ingredients are mislabeled or cross-contaminated. This is a serious concern for those with celiac disease.
The bottom line
For most healthy pregnant and breastfeeding women, eliminating gluten is generally not necessary and can lead to nutritional shortfalls. However, those with celiac disease, non-celiac gluten sensitivity or a wheat allergy do require a gluten-free diet to manage health conditions and symptoms. When gluten-free is needed, focusing on naturally gluten-free whole foods, planning balanced meals and working with your healthcare team ensures you and your baby get the nutrition you need. Being gluten-free does take some extra effort, but with the right foods and support it can be managed throughout pregnancy and breastfeeding.