Systematic Review and Meta-Analysis of Prevalence of Coeliac Disease in Women with Infertility

Abstract

We aimed to estimate the seroprevalence and the prevalence of coeliac disease (CD) in women with reproductive problems. A systematic review of English published articles until June 2019 was performed in PubMed and Scopus using the terms: (infertility and (coeliac disease OR gluten) OR (miscarriage and (coeliac disease OR gluten) OR (abortion and (coeliac disease OR gluten). All articles showing numerical data of anti-transglutaminase type 2 or anti-endomisium antibodies, or intestinal biopsy information were included. The study group comprised women with overall infertility, unexplained infertility, or recurrent spontaneous abortions. Two authors independently performed data extraction using a predefined data sheet. The initial search yielded 310 articles, and 23 were selected for data extraction. After meta-analysis, the pooled seroprevalence was very similar for overall and unexplained infertility, with a pooled proportion of around 1.3%–1.6%. This implies three times higher odds of having CD in infertility when compared to controls. The pooled prevalence could not be accurately calculated due to the small sample sizes. Further studies with increased sample sizes are necessary before giving specific recommendations for CD screening in women with reproductive problems, but current data seem to support a higher risk of CD in these women.

The prevalence of celiac disease in women with infertility—A systematic review with meta‐analysis

“…In this meta‐analysis, we observed that, when using a strict definition of CD (confirmation through biopsy and requiring Marsh III), CD is not more common in women with infertility than the general population. These findings differ from two previous meta‐analyses, 34,35 which both observed a higher CD prevalence in both women with all‐cause and unexplained infertility. For biopsy‐proven CD, Castaño et al 34 found a pooled prevalence of 1.5% (95% CI = 0.6%‐2.8%), while Singh et al 35 reported a pooled prevalence of 2.3% (95% CI = 1.4%‐3.5%).…”

“…We are aware of two earlier meta‐analyses of CD and infertility 34,35 . Both found a higher prevalence of CD in women with infertility than in the general population.…”

“…A positive association was seen for both all‐cause infertility and unexplained infertility. Singh et al 35 reported a pooled prevalence of biopsy‐proven CD in women with “all‐cause” infertility of 2.3% (95% CI = 1.4%‐3.5%), while Castaño et al 34 reported a pooled prevalence of biopsy‐proven CD in women with “overall infertility” of 1.5% (95% CI = 0.6%‐2.8%).…”

“…Castaño et al 34 did not require Marsh III histology for the celiac diagnosis, and both previous meta‐analyses had a narrow search 34,35 . Singh et al only included five studies 35 .…”

Coeliac disease and noncoeliac wheat or gluten sensitivity

“…Individuals may present with fatigue, headache, iron deficiency and osteoporosis, and this may in part explain why many individuals remain undiagnosed [1]. In addition to this, patients may present with other extraintestinal manifestations, such as dermatitis herpetiformis [17], infertility [18], neurological manifestations [19] and abnormal liver function tests (LFTs) [20]. Many individuals also present with symptoms commonly compatible with irritable bowel syndrome (IBS), leading to misdiagnosis [21].…”