Celiac disease (CeD) is a chronic immune-mediated enteropathy that adversely affects female reproductive health, particularly when disease activity, gluten exposure, or micronutrient deficiencies persist. This multidisciplinary consensus aimed to provide practical recommendations for the management of CeD and the gluten-free diet (GFD) before conception, during pregnancy, and throughout breastfeeding.
Guideline Development Group defined clinically relevant questions using the PICO framework. Evidence was systematically reviewed from PubMed, Embase, and the Cochrane Library, with certainty of evidence and strength of recommendations assessed according to GRADE. Consensus required at least 80% panel agreement.
The panel recommends preconception assessment of CeD activity, including symptoms, serology, nutritional status, and quality of GFD adherence. Normalization or significant reduction of anti-transglutaminase type 2 antibodies before conception should be pursued when feasible, while endoscopy should be reserved for selected cases. During pregnancy, regular clinical, serological, and nutritional monitoring is advised, with individualized micronutrient supplementation. Dietetic counselling should promote a nutritionally adequate GFD. During breastfeeding, intensified CeD monitoring is not routinely supported, but individualized nutritional counselling remains advisable.
These recommendations emphasize integrated gastroenterological, obstetric, and nutritional care to optimize maternal and offspring outcomes in women with CeD. They also identify evidence gaps requiring future prospective research studies. Shared decision-making should address fertility planning, medication safety, weight optimization, and coordination with care teams. Special attention is warranted for women with persistent symptoms, anemia, thyroid disease, or prior adverse pregnancy outcomes. Referral pathways and follow-up schedules may improve adherence, reduce complications, and support continuity of care across reproductive stages.