3192 Sealing the Diagnosis of Celiac Disease in Pregnancy

Abstract

INTRODUCTION: Celiac disease (CD) is an immune-mediated disease that results from a reaction to dietary gluten and primarily affects the small intestine. The diagnosis of CD can be challenging in those that do not present with the classic gastrointestinal symptoms, and the diagnosis can further be complicated in pregnancy. CASE DESCRIPTION/METHODS: A 28-year-old G1P0 woman presented with hypertension and at 15 weeks gestation. Initial workup for the patient's transaminase elevation was remarkable only for hepatic steatosis on abdominal ultrasound, with normal liver size, echogenicity and echotexture. She was diagnosed with chronic hypertension with superimposed preeclampsia complicated by transaminase elevation. However, her transaminase elevation persisted postpartum prompting re-evaluation. Further testing revealed a weakly positive anti-tissue transglutaminase antibody (IgA tTG) of 6 units/mL. Biopsy at the time of esophagogastroduodenoscopy revealed duodenal mucosa with intraepithelial lymphocytosis and focal moderate villous blunting consistent with CD. DISCUSSION: While the prevalence of CD is approximated to be one percent of the American population, it can be as high as four percent in those with cryptogenic transaminase elevation.1,2 Untreated CD during pregnancy predisposes patients to increased rates of intrauterine growth restriction (IUGR), low birth weight, and preterm birth.3 Establishing a diagnosis of CD during pregnancy can be challenging. However, prenatal screening for CD in high risk populations can lead to more cost effective care as well as improved maternal and fetal outcomes.