Eating To Conceive Dian Mills, Cert. Ed., BA, Dip. ION, MA; Mark Perloe, MD
[Prevalence of gluten-sensitive celiac disease in women with reproductive dysfunction].
PMID: 22715659 2012
Women with unexplained infertility are at
increased risk for having undiagnosed celiac disease, which may be a
potentially modifiable (and treatable) risk factor.
Increased prevalence of celiac disease in patients with unexplained infertility in the United States.
PMID:21682114 May 2011
PMID: 21561528 May 2011
PMID: 21193444 Dec 2010
Celiac disease is a mucosal disorder of the small intestine that may be triggered by dietary exposure to gluten in genetically-susceptible individuals. The disorder is often associated with diarrhea, malabsorption and weight loss along with other extra-intestinal complications. Reproductive changes have been described, including impaired fertility and adverse pregnancy outcomes possibly related to immune-mediated mechanisms or nutrient deficiency. Other possible pathogenetic factors that may alter placental function include maternal celiac disease autoantibodies binding to placental transglutaminase, and genetic mutations that may facilitate microthrombus formation. Reports noting activation during pregnancy or the puerperium may be important, and suggest that celiac disease may also be hypothetically precipitated by maternal exposure to one or more fetal antigens.
Reproductive changes associated with celiac disease.
PMID: 21155001 Dec 2010
CD has been increasingly recognized to encompass a wide variety of manifestations that are relevant to women's health, including infertility, adverse pregnancy outcomes and reduced BMD. Currently, CD is underdiagnosed, largely owing to lack of recognition of the diverse manifestations by general practitioners. Increased awareness of the clinical spectrum of this disease, as well as targeted testing in at-risk individuals (including women with unexplained infertility and previous adverse pregnancy outcomes, and in specific populations with reduced BMD) is greatly needed in order to improve rates of diagnosis.
Celiac disease: an underappreciated issue in women's health.
PMID: 20887172 Sept 2010
Womens Health (Lond Engl). 2010 Sep;6(5):753-66.PMID: 20887172ABSTRACT: BACKGROUND: The aim of this study is to explore the association between celiac disease and menstrual cycle, gestation and puerperal disorders. METHODS: The association between celiac disease and menstrual cycle, gestation and puerperal disorders in a sample of 62 childbearing age women (15-49 age) was assessed within an age and town of residence matched case-control study conducted in 2008. Main outcome measures were the presence of one or more disorders in menstrual cycle and the presence of one or more complication during pregnancy. RESULTS: 62 celiac women (median age: 31.5, range: 17-49) and 186 healthy control (median age: 32.5, range: 15-49) were interviewed. A higher percentage of menstrual cycle disorders has been observed in celiac women. 19.4% frequency of amenorrhea was reported among celiac women versus 2.2% among healthy controls (OR=33, 95% CI=7.17-151.8;, p=0.000). An association has been observed between celiac disease and oligomenorrhea, hypomenorrhea, dysmenorrhea and metrorrhagia (p<0.05). The likelihood of having at least one complication during pregnancy has been estimated to be at least four times higher in celiac women than in healthy women (OR=4.1, 95% CI=2-8.6, p=0.000). A significant correlation has emerged for celiac disease and threatened abortion, gestational hypertension, placenta abruption, severe anaemia, uterine hyperkinesia, intrauterine growth restriction (p<0.001). A shorter gestation has on average been observed in celiac women together with a lower birthweight of celiac women babies (p<0.001). CONCLUSIONS: The occurrence of a significant correlation between celiac disease and reproductive disorders could suggest to consider celiac disease diagnostic procedures (serological screening) in women affected by these disorders.
Reproductive life disorders in Italian celiac women. A case-control study.
PMID: 20691041 Aug 2010
Abstract Background: Premature ovarian failure is diagnosed with a picture of amenorrhea, elevated follicle-stimulating hormone (FSH), and age under 40 years. Twenty percent (20%) of patients with premature ovarian failure have a concomitant autoimmune disease. Cases of premature ovarian failure associated with Sjögren syndrome have been reported in the literature. Patient and method: We report a case of a 42-year-old white woman with Sjögren syndrome and premature ovarian failure who underwent a reversal of her premature ovarian failure and restoration of normal menses using an elimination diet protocol. The patient was diagnosed with her rheumatological condition in 2005 and started on disease-modifying antirheumatoid drugs, which were taken intermittently due to a concern over medication side-effects. Her menses became irregular at the time of initial diagnosis and finally ceased in 2006, with a dramatic elevation in her FSH, indicative of autoimmune-induced premature ovarian failure. In March 2009, she commenced an elimination diet protocol, eliminating gluten, beef, eggs, dairy products, nightshade vegetables, refined sugars, and citrus fruit for 4 months. Results: Her repeat laboratory tests after 4 months showed a drop in FSH from 88 to 6.5 and a drop in erythrocyte sedimentation rate from 40 to 16. Her menses also resumed and her rheumatological symptoms significantly improved. Conclusions: It is hypothesized that the restoration of normal menses was caused by reduced inflammation in the ovarian tissue and supports the hypothesis that the gut immune system can influence autoimmune disease and inflammation.
Reversal of premature ovarian failure in a patient with sjögren syndrome using an elimination diet protocol..
PMID: 20618099 July 2010
OBJECTIVE: To report a case of a
woman presenting with primary infertility who on investigation was found
to have celiac disease and had a successful conception when on a
gluten-free diet for a period of 8 months. DESIGN: Case report. SETTING:
Tertiary care university hospital. PATIENT(S): A 30-year-old female
patient with primary infertility. INTERVENTION(S): Gluten-free diet.
MAIN OUTCOME MEASURE(S): Successful pregnancy. RESULT(S): On
investigation she had microcytic hypochromic anemia and high titers of
IgA tissue transglutaminase. Duodenal biopsy was done and histology was
suggestive of celiac disease. The patient was put on gluten-free diet.
Eight months later she had a successful conception. CONCLUSION(S): We
suggest that celiac disease should be checked in infertile patients of
unexplainable etiology with anemia, as just changing their diet can
solve their fertility problem.
Primary infertility as a rare presentation of celiac disease.
PMID: 20537625 May 2010
Reproductive problems, such as delayed menarche, amenorrhea, early menopause, infertility, impotence, hypogonadism, recurrent abortions, and low-birth-weight or preterm deliveries, are now known to be among the atypical symptoms of coeliac disease (CD). The pathogenesis of reproductive disorders in CD is unclear, but some hypotheses have been suggested, including autoimmunity and macro- and/or micronutrient deficiency. Recent investigations which have focused on tissue transglutaminase are promising with respect to the clarification of the mechanism of infertility and poor pregnancy outcomes in CD. In this review, the effects of CD on male and female reproductive disorders and pregnancy outcomes are discussed and the need for CD screening in the case of reproductive problems is emphasized.
Coeliac disease and reproductive disorders.
PMID: 20017709 Dec 2009
Early pregnancy loss in celiac women: The role of genetic markers of thrombophilia.
PMID: 19395327 April 2009
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.
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.
We confirmed higher incidence of celiac disease in women with impaired fertility.
Celiac disease and fertility disorders in women.
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.
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.
Fertility problems, sexual dysfunction and obstetrical complications are more frequently observed in patients with coeliac disease.
Coeliac disease and reproductive disorders: a neglected association.
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.
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.
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.
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.
Coeliac disease, anaemia and pregnancy.
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
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.
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.