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    Reproductive effects of celiac disease

    There is an established relationship between overt celiac disease and adverse reproductive consequences, including infertility. Celiac disease also has been suggested as a contributor to recurrent pregnancy loss.



    Clinical management

    There are no interventions known to prevent development of CD, although breastfeeding is associated with a 50% reduction in risk when gluten is introduced before the infant is weaned.1,24 Patients presenting with typical symptoms of CD including diarrhea, abdominal pain, and malabsorption should have serologic screening with anti-tissue transglutaminase IgA and/or endomysial antibodies. Testing should be completed before starting therapy. Patients with atypical pelvic pain, particularly with GI components, may also benefit from screening. The current literature does not consistently support silent CD as a cause of unexplained infertility or recurrent pregnancy loss, and routine screening is not recommended. Patients at risk for CD may have HLA-DQ2 and HLA-DQ8 testing.

    Patients with negative serology should also be tested for total IgA levels to exclude an isolated IgA deficiency (Figure). After positive serologic screening, endoscopy with upper GI biopsies should be recommended to establish the diagnosis. If confirmatory, a gluten-free diet should be advised.

    Because adherence to a gluten-free diet is difficult and requires a lifelong commitment, both patient and physician should have clear expectations for potential benefit at the outset. Pregnant patients and those planning to conceive in the near future can expect to reduce the risks of preterm delivery, low-birth-weight infants, and IUGR associated with overt CD. Patients known to have CD should expect to have near-normal fertility potential with appropriate diet, but the benefits of adopting a gluten-free diet in patients with silent CD are unproven. 













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    7. Nilsen EM, Jahnsen FL, Lundin KE, et al. Gluten induces an intestinal cytokine response strongly dominated by interferon gamma in patients with celiac disease. Gastroenterology. 1998;115(3):551-563.

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    10. Bradley RJ, Rosen MP. Subfertility and gastrointestinal disease: ‘unexplained’ is often undiagnosed. Obstet Gynecol Surv. 2004;59(2):108-117.

    11. Jackson JE, Rosen M, McLean T, Moro J, Croughan M, Cedars MI. Prevalence of celiac disease in a cohort of women with unexplained infertility. Fertil Steril. 2008;89(4):1002-1004.

    12. Choi JM, Lebwohl B, Wang J, et al. Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med. 2011;56(5-6):199-203.

    13. Zugna D, Richiardi L, Akre O, Stephansson O, Ludvigsson JF. A nationwide population-based study to determine whether coeliac disease is associated with infertility. Gut. 2010;59(11):1471-1475.

    14. Nenna R, Mennini M, Petrarca L, Bonamico M. Immediate effect on fertility of a gluten-free diet in women with untreated coeliac disease. Gut. 2011;60(7):1023-1024. 

    15. Gasbarrini A, Torre ES, Trivellini C, De Carolis S, Caruso A, Gasbarrini G. Recurrent spontaneous abortion and intrauterine fetal growth retardation as symptoms of coeliac disease. Lancet. 2000;356(9227):399-400.

    16. Greco L, Veneziano A, Di Donato L, et al. Undiagnosed coeliac disease does not appear to be associated with unfavourable outcome of pregnancy. Gut. 2004;53(1):149-151.

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    18. Khashan AS, Henriksen TB, Mortensen PB, et al. The impact of maternal celiac disease on birthweight and preterm birth: a Danish population-based cohort study. Hum Reprod. 2010;25(2):528-534.

    19. Ludvigsson JF, Montgomery SM, Ekbom A. Celiac disease and risk of adverse fetal outcome: a population-based cohort study. Gastroenterology. 2005;129(2):454-463.

    20. Rostom A, Dubé C, Cranney A, et al. The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology. 2005;128(4 suppl 1):S38-S46.

    21. Catassi C, Fabiani E, Iacono G, et al. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr. 2007;85(1):160-166.

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    24. Szajewska H, Chmielewska A, Piéscik-Lech M, et al; PREVENTCD Study Group. Systematic review: early infant feeding and the prevention of coeliac disease. Aliment Pharmacol Ther. 2012;36(7):607-618.

    Steven J. Ory, MD
    Dr. Ory is a professor of obstetrics and gynecology, Florida International University College of Medicine, Miami, and a partner at IVF ...
    Daniel R. Christie, MD
    Dr. Christie is a partner at IVF Florida Reproductive Associates, Margate.


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