Original article
Smoking and Celiac Disease: A Population-Based Cohort Study

https://doi.org/10.1016/S1542-3565(05)00414-3Get rights and content

Background & Aims: Earlier studies indicate a protective effect of smoking against celiac disease (CD), but have been based on small numbers and retrospective collection of smoking data. Methods: We linked the Swedish national inpatient register and the medical birth register to study the association between smoking status during pregnancy and CD (diagnosed or undiagnosed at delivery) in women who were pregnant from 1983 to 2001. We adjusted for civil status, age, and year when smoking data were collected. We identified 873 cases of CD (636 diagnosed and 237 undiagnosed). Results: Of 249,967 smokers, 67 (.27%) had undiagnosed CD (vs 170 of 794,912 nonsmokers [.21%]) (odds ratio [OR], 1.25; 95% confidence interval [CI], .94–1.66; P = .118). Point estimates remained unchanged when adjusting for civil status, age, and year of smoking data collection (adjusted OR [AOR], 1.25; 95% CI AOR, .94–1.67). There were no associations between smoking and future (undiagnosed at delivery) CD when we adjusted for potential confounders and stratified for comorbidity or time to diagnosis (<5 vs ≥5 y after infant birth). In women with diagnosed CD, smoking was more common than in women who never had a diagnosis of CD (AOR, 1.36; 95% CI AOR, 1.12–1.64; P = .002). Conclusions: Smoking seems to have little effect on the risk for future CD in pregnant women.

Section snippets

Participants

Since 1973, professional health care personnel have collected health data on pregnant women and their offspring (liveborns and stillborns alike). Since 1983, the medical birth register also contains data on maternal smoking in gestational week 12. Information is collected throughout pregnancy and at birth on structured forms. These forms constitute the basis for the computerized medical birth register maintained by the Swedish National Board of Health and Welfare. In Sweden, more than 99% of

Background Data

We had smoking data on 1,045,515 women, 250,126 of whom were smokers (Table 1). We identified 873 women with a hospital discharge diagnosis of CD (Table 1). Among women with a diagnosis of CD at infant birth, 513 of 636 had CD listed as their main diagnosis (80.7%); whereas the corresponding proportion among women with undiagnosed CD was 45.1% (107 of 237). Most women with undiagnosed CD received their diagnosis 5 years or more after infant birth (150 of 237).

The majority of women were aged

Discussion

This study found that smoking status during pregnancy was not associated with undiagnosed CD at delivery. Neither could smoking be linked with undiagnosed CD in subgroups of women with CD diagnosed within 5 years after infant birth or according to the presence of comorbidity. However, in women who already had received a diagnosis of CD, smoking was more common than in women who never received a diagnosis of CD.

This large cohort study comparing the risk for undiagnosed CD in smokers vs

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    Supported in part by a grant from the Örebro University Hospital (to J.F.L.), the Swedish Society of Medicine, the Swedish Research Council, and the Majblomman Foundation.

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    Copyright © 2005 American Gastroenterological Association. Published by Elsevier Ltd. All rights reserved.