Reproductive Characteristics and Pregnancy Outcomes in Hidden Celiac Disease Autoimmunity

Abstract

INTRODUCTION: Untreated symptomatic celiac disease (CD) adversely affects female reproduction; however, the effect of hidden CD autoimmunity is uncertain. METHODS: We identified women who were not previously diagnosed with CD and tested positive for tissue transglutaminase and endomysial antibodies between 2006 and 2011 in a community-based retrospective cohort study. We evaluated (i) the rate of adverse pregnancy outcomes and medical complications of pregnancy in successful singleton deliveries and (ii) reproductive characteristics in seropositive women without a clinical diagnosis of CD and age-matched seronegative women. RESULTS: Among 17,888 women whose serum samples were tested for CD autoimmunity, 215 seropositive and 415 seronegative women were included. We reviewed 231 and 509 live singleton deliveries of 117 seropositive and 250 seronegative mothers, respectively. Menarche and menopausal age, gravidity, parity, and age at first child were similar in seropositive and seronegative women. CD seropositivity was not associated with an increased risk of maternal pregnancy complications. Maternal seropositivity was associated with small for gestational age in boys (OR 3.77, 95% CI: 1.47–9.71; P = 0.006), but not in girls (OR 0.57, 95% CI: 0.15–2.17; P = 0.41). CD serum positivity was not associated with prematurity, small for gestational age (birth weight <10th percentile), or 5-minute Apgar score of less than 7. DISCUSSION: Although underpowered, the present study did not show any difference in reproductive characteristics or rates of adverse pregnancy outcomes in women with and without CD autoimmunity, except for birth weight in male offspring. Larger studies are needed to determine the effects of CD autoimmunity on female reproduction.

Adverse pregnancy outcomes in women with celiac disease: a systematic review and meta-analysis

“…Based on data from 4 cohort studies [ 29 , 32 , 33 , 46 ], among 5399 pregnancies of women with CD and 14,882,102 control pregnancies, there were 134 (2.5%) and 511,846 (3.4%) cases of preeclampsia, respectively. The association between CD pregnancies and the risk for preeclampsia was not statistically significant (RR 1.04, 95%CI 0.88-1.23).…”

“…In this analysis of 4 cohort studies [ 31 , 32 , 40 , 45 ], including 503 pregnancies with CD and 387,848 control pregnancies, the 5-min Apgar score was <7 in 2% (n=10) and in 1.7% (n=6483), respectively. There was no indication of an elevated risk for 5-min Apgar score <7 in the study group compared to the control group (RR 1.40, 95%CI 0.46-4.22).…”

“…With regard to a previous meta-analysis [ 7 ], we further evaluated 2 important pregnancy outcomes: spontaneous abortion and cesarean delivery; they proved to be significantly associated with CD pregnancies. Notably, most of the individual observational studies reported no statistically significant results regarding spontaneous abortion [ 34 , 35 , 40 , 42 ] and cesarean delivery [ 32 - 34 , 38 , 41 ], while the meta-analysis detected 35% and 10% higher risk for pregnancies with CD, respectively. The increased risk of pregnancy complications could be attributed to nutrient deficiencies [ 43 ] or the potential compromise of placental function by gliadin and/or maternal CD antibodies [ 47 ].…”

Review article: Systemic consequences of coeliac disease

“…Interestingly, high levels of serum coeliac autoantibodies have been associated with foetal growth restriction 57 . However, in another study an association was only reported between untreated coeliac seropositivity and small‐for‐gestational age in boys, but not with other adverse pregnancy outcomes 58 . Notwithstanding these partly controversial results, in addition to dietary counselling in general, specific focus on a strict gluten‐free diet could be beneficial for women with coeliac disease who are pregnant or planning pregnancy.…”

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling

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