Infertility and Miscarriage

The Gluten File

PubMed Abstracts

Permanent intolerance to gluten, known as celiac disease, affects both fertility and pregnancy outcomes when left untreated. Recent research on celiac disease and reproduction urge increased screening for celiac disease. While this may be beneficial for couples facing idiopathic infertility or those from particular risk groups, screening involves its own risks and expenses, and has not been consistently proven effective for the general population while pregnant. The present editorial discusses the potential advantages and disadvantages of screening during pregnancy and examines when screening may be helpful.
Celiac disease during pregnancy: to screen or not to screen?
PMID: 18818937  Sept 2008

Discussion: antiphospholipid syndrome is characterized by arterial and venous thrombosis, and spontaneous fetal death. Its association with celiac disease has been described in few cases. Celiac disease is associated with spontaneous fetal death; consequently, we hypothesize that antiphospholipid syndrome may be one of the causes for this event.
Celiac disease associated with antiphospholipid syndrome.
PMID: 18366270 Feb 2008

Purpose Available literature data show that celiac disease (CD) is a frequent cause of recurrent miscarriage. However, data are lacking for pregnancy outcome when the patient is on a gluten-free diet (GFD). A case-control study about the effect of GFD on pregnancy was conducted from 1995 to 2006. A cohort of 13 women (mean age 32 years, range 22-38 years) affected by CD with recurrent miscarriages was observed. In all of them several causes of miscarriage (gynecological, endocrine, hematological, etc.) were excluded. All patients were started on a gluten-free diet and were reassessed throughout a long-term follow-up period to evaluate the outcome of pregnancy. Results Six of 13 became pregnant (46.15%) as follows: 1 patient (7.69%) 1 year after GFD was started, 3 patients (23.07%) 2 years after GFD was started, 1 patient (7.69%) after 3 years, and finally 1 (7.69%) 4 years after GFD was started. Moreover, two patients (16.66%) had multiple pregnancies (one had had two childbirths and another had undergone three births within a 7-year follow-up period under GFD). Conclusions GFD seems to favor a positive outcome of pregnancy in most CD patients with recurrent miscarriage.
Effect of Gluten-Free Diet on Pregnancy Outcome in Celiac Disease Patients with Recurrent Miscarriages.
PMID: 18368491  March 2008

The male CD patient has a greater risk of infertility and other reproductive disturbances, as well as a greater incidence of hypoandrogenism.
[Celiac disease and its endocrine and nutritional implications on male reproduction]PMID: 15289752 June 2004

The significant findings were observed as follow: adult celiac patients, irrespective of the nutritional status, were younger than controls, presented delayed menarche, secondary amenorrhea, a higher percentage of spontaneous abortions, anemia and hypoalbuminemia. .... In conclusion, gluten per se could explain the disturbances and malnutrition would worsen the disease in a consequent vicious cycle. Therefore, celiac disease should be included in the screening of reproductive disorders.
Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease. PMID: 15232359 Aug 2004

Because unexplained infertility can represent the initial presentation of undiagnosed medical disease, considering these often-subclinical gastrointestinal disorders in the differential diagnosis of subfertility provides an opportunity not only to increase the probability of conception and uncomplicated pregnancy, but also to improve overall maternal health.
Subfertility and gastrointestinal disease: 'unexplained' is often undiagnosed. PMID: 14752299

Undiagnosed coeliac disease is not uncommon in adults in the UK and can be a cause of unexplained infertility in women
Coeliac disease and infertility: making the connection and achieving a successful pregnancy. PMID: 12416015

We confirmed higher incidence of celiac disease in women with impaired fertility.
Celiac disease and fertility disorders in women. PMID: 12749174

Undiagnosed coeliac disease is frequent among pregnant women (>1%) but is not associated with an unfavourable outcome of pregnancy.
Undiagnosed coeliac disease does not appear to be associated with unfavourable outcome of pregnancy. PMID: 14684590

Many studies have shown that coeliac women are susceptible to reproductive difficulties such as infertility and miscarriages. The disease is also associated with low birth weight in babies and short duration of breast feeding. Folic acid deficiency is present in the majority of patients with untreated disease and it might be a maternal risk factor for neural tube defects and orofacial clefts. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy.
Coeliac disease and problems associated with reproduction. PMID: 11398587

Fertility problems, sexual dysfunction and obstetrical complications are more frequently observed in patients with coeliac disease.
Coeliac disease and reproductive disorders: a neglected association. PMID: 11384797

Epidemiological studies show that besides reduced fertility, affected women are at higher risk of reproductive problems such as pregnancy loss, low birthweight of offspring and reduced duration of breastfeeding.
There are no adequate studies to evidentiate a possible increase of birth defects; nevertheless, coeliac disease induces malabsorption, with deficiencies of nutritional factors essential to prenatal development such as iron, folic acid and vitamin K.
Celiac disease. Risk factors for women in reproductive age. PMID: 11048475

Patients having fertility problems may have subclinical coeliac disease, which can be detected by serological screening tests. Silent coeliac disease should be considered in the case of women with unexplained infertility.
Infertility and coeliac disease. PMID: 8949641

Gluten withdrawal and correction of deficient dietary elements can lead to a return of fertility both in men and women.
Infertility, obstetric and gynaecological problems in coeliac sprue. PMID: 7988065

The main aim of this study was to investigate the association between celiac disease and abortion, and in particular to evaluate whether patients suffering from recurrent spontaneous abortion might present an atypical or subclinical form of the disease.
Celiac disease and spontaneous abortion. PMID: 12032453

Coeliac disease, anaemia and pregnancy. PMID: 11596908

This study suggests that even treated coeliac disease, in either of the parents, has a negative effect on pregnancy, resulting in lower birth weight and perhaps shorter duration of pregnancy.
Coeliac disease in the father affects the newborn PMID: 11454790

It appears that improvement of celiac disease, as reflected by restoration of small bowel mucosa associated with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall perinatal outcome.
Celiac disease: fertility and pregnancy.PMID: 11150866

Women having recurrent miscarriages or intrauterine growth retardation could have subclinical coeliac disease, which can be detected by serological screening tests.
Recurrent spontaneous abortion and intrauterine fetal growth retardation as symptoms of coeliac disease. PMID: 10972376