If you've been avoiding gluten because you have celiac disease or a gluten allergy, you may be wondering if you're getting all the nutrients you need. Do you need to change your diet now that you're eating for two?
Gluten, a protein that gives foods structure and texture, is naturally found in most products made from grains, including wheat, barley and rye. That puts foods made with wheat flour off limits, like breads, crackers, cereals, pasta, cakes, cookies and pies.
Gluten can also show up in store-bought or restaurant foods and drinks including beer, coated French fries, hot dogs, sausages, some salad dressings and soy sauces, soups, licorice candy and veggie burgers.
If you have celiac disease, gluten can trigger an immune system reaction that over time damages the lining of the small intestine, with symptoms including diarrhea, fatigue and joint pain. Wheat allergy, another form of gluten intolerance, not only causes intestinal problems but can also provoke classic allergy symptoms such as hives, itching, nasal congestion and potentially fatal respiratory reactions. People with the skin disorder dermatitis herpetiformis should also eat gluten-free.
Of course if you do have celiac disease, dermatitis herpetiformis, or any type of food allergy, be sure to let your OB/GYN or midwife know about your dietary restrictions so she can help you monitor your nutrition during your pregnancy.
But even without a medical diagnosis of an allergy or intolerance, some people have chosen to eliminate gluten from their diets just because they say they feel better when they avoid gluten-containing foods.
Though there haven't been robust studies of how gluten-free diets may affect pregnancy and childhood development, rest assured that by working with your practitioner, you can easily plan a healthy pregnancy diet that ensures you're getting all the nutrients you and your baby need. Here's everything you need to know about following a gluten-free diet during pregnancy.
More About Healthy Pregnancy Nutrients
Is a gluten-free diet safe during pregnancy?
It’s safe to avoid gluten when you’re pregnant, but it isn’t always a good idea to do so.
For women with celiac disease or other medical conditions triggered by the consumption of gluten or wheat (like a wheat allergy or dermatitis herpetiformis), eating a gluten-free diet is a must.
In fact, recent research shows that, for pregnant women with celiac disease, avoiding gluten may reduce the risk of having a baby with certain heart or urinary birth defects. People with celiac disease who follow a gluten-free diet are also less likely to develop health problems like anemia or osteoporosis, or struggle with infertility, compared to those who continue consuming gluten.
As for going gluten-free for other reasons? Despite the negative attention gluten has gotten in recent years, there’s no good evidence showing that people without celiac disease, wheat allergies or dermatitis herpetiformis will benefit from eating gluten-free diets. Eating gluten during pregnancy won’t increase your baby’s chances of developing celiac disease either, research shows.
What’s more, gluten-free diets can make it harder to get certain nutrients that are important for moms-to-be and their growing babies. Carbohydrates from gluten-containing foods are an important source of energy. And whole grain and enriched foods containing gluten (like whole wheat bread or cereal) offer fiber, folic acid, iron and B vitamins.
So while you should stick with a gluten-free diet if it’s a medical necessity, think twice about eating gluten-free for other reasons. And whether you need to avoid gluten or opt to do so as a matter of preference, work with your doctor or midwife and a registered dietician to ensure you and your baby are getting the nutrition you both need.
Can gluten intolerance develop during pregnancy?
Celiac disease can develop at any age. What’s more, a handful of small studies have shown a link between pregnancy and celiac disease or gluten intolerance.
That’s not to say that pregnancy causes women to have problems with gluten. But it’s worth being aware of the symptoms of celiac disease or gluten intolerance and talking with your doctor if you’re experiencing possible signs lasting longer than two weeks. Simple tests can be performed to confirm your diagnosis.
Common symptoms of celiac disease or a gluten intolerance include:
Diarrhea or constipation
Nausea or vomiting
Bloating or abdominal pain
Fatigue or headaches
Unexplained weight loss
Anemia
Itchy or blistery skin rashes
Mouth ulcers
Joint pain
Numbness or tingling in the hands or feet.
What can you eat on a gluten-free diet during pregnancy?
Eliminating grains from your diet means cutting out a major source of B vitamins (including folate), fiber and important minerals (like iron and zinc) — all of which either occur naturally or are added during processing.
Fortunately, many gluten-free foods offer these and other nutrients, so don't stress about filling your plate with foods you can't stomach. What's more, a standard prenatal vitamin is your insurance policy to ensure you get all you need and more.
Still, during pregnancy it's worth making an extra-special effort to get plenty of the following nutrients from gluten-free sources:
Folate
Possibly the most essential nutrient when you're expecting, folate helps prevent birth defects like spina bifida. The government requires food manufacturers to add it to some flours and commonly eaten grains (breads, pastas and cereals) — but since many gluten-free products are not made with this enriched flour, you should make sure to check the folate levels on the nutrition label of the goods you buy.
Since prenatal vitamins have at least 400 mcg (and prescription prenatals often have even more, sometimes up to 1000 mcg), you can meet your pregnancy requirement of 400 to 600 mcg per day from all sources pretty easily. Just make sure you know how much folic acid your vitamin is providing and then fill up your plate with natural gluten-free folate foods, including:
Spinach (131 mcg in ½ cup cooked)
White rice (90 mcg in ½ cup cooked)
Asparagus (89 mcg in 4 spears boiled)
Avocado (60 mcg in half an avocado)
Kidney beans (46 mcg in ½ cup canned, cooked)
Iron
Iron helps you create red blood cells that carry oxygen to your whole body — vital when you're growing a baby, since your body's pumping a whole lot more blood.
In fact, pregnant women are at a greater risk of anemia (or low red blood cell count), so do your best to get at least 27 mg per day from gluten-free sources. The most iron-rich gluten-free foods have about 3 to 4 mg per serving. These include:
Red meat or dark meat poultry (about 2 mg in 3 ounces cooked; also a good source of B vitamins and minerals)
Legumes like chickpeas, black beans or kidney beans (about 3 to 4 mg in 1 cup cooked)
Spinach (6 mg in 1 cup cooked)
Bonus: These foods also provide approximately 0.9 to 7 mg of zinc to help you meet your requirement of 11 mg per day.
Fiber
Since you're more likely to get constipated during pregnancy, make your goal at least 25 grams of fiber (and plenty of water) per day. Your go-to foods include:
Legumes (get 10 to 16 g of fiber per cup of cooked beans, lentils or split peas)
Brown rice (3.5 g in 1 cup cooked); note that it contains some inorganic arsenic — so while having some rice in your diet is fine, you wouldn't want it to be your only source of fiber
Nuts (3 g in 1 ounce)
Fruits and veggies (5 g in one large apple; 4 g in 2 large kiwis; 3 g in an orange; 3 g in one medium stalk of broccoli; 3 g in 3/4 cup cut green beans; 4 g in one medium sweet potato)
Calcium
The mineral is a must for strengthening your baby’s developing bones and teeth — and it protects yours as well. Calcium also plays a key role in your baby’s muscle, heart and nerve development.
Pregnant women need 1,000 mg of calcium a day and women under 18 need 1,300 mg per day. That adds up to about four servings of calcium-rich foods daily.
Fortunately, many of the best sources of calcium are naturally gluten-free (though it’s always a good idea to check a food’s ingredient label if you’re unsure). These include:
Plain low-fat yogurt (415 mg per cup)
Milk or fortified soy milk (276 to 299 mg per cup, depending on the fat content)
Part-skim mozzarella cheese (333 mg in 1.5 ounces)
Sardines canned in oil with bones (325 mg in 3 ounces)
Fortified orange juice (349 mg per cup)
Low-fat cottage cheese (138 mg per cup)
Zinc
Zinc supports your baby’s cell growth and may play a role in preventing low birth weight and other complications during labor and delivery. It helps keep your immune system in fighting form too, so you’re better able to fend off colds and infections during pregnancy.
Moms-to-be should aim for 11 mg of zinc per day (but no more than 40 mg per day). You can get it from gluten-free sources like:
Lean beef or dark meat poultry (get 7 mg in 3 ounces of chuck roast and 2.4 mg in 3 ounces of dark meat chicken)
Pork (2.9 mg in 3 ounces of pork chop loin)
Low-fat yogurt (1.7 mg per cup)
Baked beans (2.9 mg per ½ cup)
Nuts and seeds (get 1.7 mg in 1 ounce of pumpkin seeds, 1.6 mg in 1 ounce of cashews, or .9 mg in 1 ounce of almonds)
Vitamin D
Vitamin D works with calcium to support the development of your baby’s bones and teeth, and getting enough could play a role in reducing your risk for pregnancy complications like preeclampsia, gestational diabetes and low birth weight.
Pregnant and breastfeeding women should get at least 600 IU of vitamin D daily. You can get most or all of that from your prenatal vitamins — many provide about 400 to 600 IUs of vitamin D — but you can also fill up on vitamin D-rich, gluten-free foods like:
Fatty fish (645 IU in 3 ounces of cooked rainbow trout, 570 IU in 3 ounces of sockeye salmon, or 44 IU in two oil-packed sardines)
Fortified dairy or nondairy milk (between 100 and 144 IU per cup)
Eggs (44 IU per egg)
What should you avoid eating on a gluten-free diet during pregnancy?
The short answer: Anything that contains gluten! Some of these foods are obvious offenders — since gluten is a protein found in wheat, barley and rye, all items made with wheat flour are off-limits. You should steer clear of:
Gluten-containing grains
Wheat, barley and rye are the three biggies. Also avoid triticale (a cross between wheat and rye), wheat germ, wheat bran einkorn, cracked wheat, farina, graham flour, durum wheat or any other flour not labeled gluten-free.
Check corn, rice and oat products before buying. While they’re technically gluten-free, these items may be contaminated with wheat gluten if they’re produced in a factory that also processes wheat products.
Wheat-based bread, pasta and baked goods
If it’s made with all-purpose or whole wheat flour, it contains gluten. That includes breads and rolls, pasta, pizza, flour tortillas, crackers, waffles, pancakes, bagels, cakes, cookies, pies, muffins, cupcakes and so on.
Other packaged foods and ingredients aren’t off-limits across the board. But because gluten can also lurk in many foods that you might not expect, it’s important to scrutinize food labels and ingredient lists before buying or eating. Check these carefully before eating:
Packaged foods and drinks
Though this list isn’t necessarily all-encompassing, you’ll often find gluten in:
Beer, ale and lagers
Bouillon cubes
Brown rice syrup
Candy
Chips, including potato chips
Deli meats, hot dogs, salami and sausage
Communion wafers
Frozen meals
Frozen French fries
Gravy
Imitation fish
Matzo
Rice mixes
Pre-made sauces
Bottled salad dressings
Seasoned tortilla chips
Self-basting turkey
Canned soups
Soy sauce
Vegetables in sauce
Other ingredients
Many packaged foods contain emulsifiers such as dextrin, modified food starch and mono- and diglycerides, as well as seasonings or caramel color. These ingredients can contain gluten, so avoid them unless a food is specifically certified gluten-free.
What about gluten-free alternatives?
While it’s perfectly fine to enjoy gluten-free versions of your favorite foods (like gluten-free breads or baked goods), make moderation the name of the game. Many processed gluten-free foods are high in sugar and saturated fat and low in nutrients, so they don’t offer much to support a healthy pregnancy and baby.
The bottom line? Treat yourself once in a while, but make sure the majority of your meals and snacks are based around whole foods like lean proteins, fruits and vegetables, low-fat dairy, beans, nuts and seeds, and gluten-free whole grains like quinoa or brown rice.
Easing nausea when you’re pregnant and gluten-free
Early in your pregnancy, nausea may cause carb cravings — which means you may long for a piece of bread or a few crackers to ease the quease. The trick? Stock up on gluten-free bread and cracker alternatives; you should have your pick (even a gluten-free aisle!) at most grocery stores.
What you should know about going gluten-free in your pregnancy
Between nausea, constipation and an increasingly limited selection of foods in your fridge, it can seem trickier than ever to get a balanced diet when you're expecting.
But rest assured, by eating a variety of foods from all food groups — proteins, fruits, vegetables, dairy/dairy alternatives and grains — you can get all the nutrients you and your growing baby need.
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