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Does gluten intake in pregnancy affect type 1 diabetes risk in offspring?

By Nicole MacKee
Women who have a high gluten intake during pregnancy may be at increased risk of having a child who develops type 1 diabetes, say Danish researchers, but a local expert has urged caution in interpreting the findings.

The prospective cohort study, published in the BMJ, evaluated the gluten intake of almost 70,000 pregnant women and the subsequent incidence of type 1 diabetes in their children over a follow up of about 15 years. Gluten intake was assessed using food frequency questionnaires during the second trimester of pregnancy.

During follow up, 247 children developed type 1 diabetes (0.37%). The researchers found that women with the highest intake of gluten during pregnancy (20g daily or more) were twice as likely to have a child with type 1 diabetes as women with the lowest intake (less than 7g daily; adjusted hazard ratio, 2.00). However, the researchers said further, preferably interventional, studies were needed to confirm any causal link.

Dr Sarah Price, endocrinologist at the University of Melbourne and President of the Australian Diabetes in Pregnancy Society, said the possible role of maternal gluten intake in the development of type 1 diabetes was an interesting area of study, but emphasised the exploratory nature of the Danish study.

‘The researchers and editorial make it quite clear that many uncertainties remain,’ she said, also noting the small proportion of children who developed type 1 diabetes during the study.

In an accompanying editorial, Finnish experts wrote that it was too early to change dietary recommendations for gluten intake during pregnancy. They noted that a high gluten diet may be indicative of an unhealthy or high-energy diet that may also predispose a mother’s offspring to type 1 diabetes.

Dr Price agreed that standard dietary recommendations during pregnancy should remain for now.

‘Women should continue to be encouraged to eat a healthy, balanced diet prior to and during pregnancy. If women have an interest in this area, they also can also be encouraged to participate in one of several studies investigating the environmental determinants of autoimmunity.’

Dr Price suggested that clinicians seeing women with type 1 diabetes, or women who have a partner or child with type 1 diabetes, could be referred to the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study, which is currently recruiting patients (www.endia.org.au).
BMJ 2018; 362: k3547.
BMJ 2018; 362: k3867.