New study links undiagnosed celiac disease to miscarriages and stillbirths

Once celiac disease is treated with a gluten-free diet, however, women’s risks of pregnancy complications return to normal levels.

Women with undiagnosed celiac disease may be more likely to have miscarriages or stillbirths than women who never get this diagnosis, a Danish study suggests.

Once celiac disease is identified and treated with a gluten-free diet, however, women’s risks of pregnancy complications return to normal levels.

For the study, researchers examined data on pregnancy outcomes for 6,319 women diagnosed with celiac disease and a comparison group of 63,166 similar women who didn’t have this diagnosis.

Overall, there wasn’t any difference in the number of pregnancies between the women who later got a celiac disease diagnosis and the women who didn’t. And the overall chance of live births, miscarriages, and other pregnancy complications was similar for both groups of women.

But during the years prior to a celiac disease diagnosis, women who later received this diagnosis were 12 percent more likely to have a miscarriage and 62 percent more likely to experience a stillbirth than expectant mothers who never developed this condition.

“We were able to confirm that there were no increased risks of adverse pregnancy outcomes when the woman were diagnosed with celiac disease before the reproductive event - and therefore presumably were treated with gluten free diet,” said lead study author Louise Grode, a researcher at Horsens Regional Hospital in Denmark.

About one in 100 people have celiac disease, in which consumption of gluten triggers an autoimmune response that damages the small intestine and impairs the body’s ability to absorb nutrients from food. Left untreated, the condition can lead to complications such as malnutrition, low bone density, lactose intolerance and infertility.

People with celiac disease are advised to go on a gluten-free diet, avoiding foods that contain even small amounts of wheat, barley, rye or any derivatives of these grains.

The study results suggest that women who have unexplained fertility problems, miscarriages or stillbirths might want to be tested for celiac disease to see if this might be contributing to these problems, Grode said by email.

Undiagnosed celiac disease was associated with 15 percent higher odds of any adverse pregnancy outcomes in the period more than five years prior to diagnosis, compared with women who never developed celiac disease, researchers report in Human Reproduction.

The study wasn’t a controlled experiment designed to prove whether or how undiagnosed celiac disease might directly impact pregnancy outcomes. It also wasn’t designed to assess how diagnosing and treating celiac disease might alter women’s chances of having a baby.

Another limitation is that researchers lacked data on two major risk factors for infertility pregnancy complications: smoking and obesity.

Still, the findings build on previous research suggesting that, properly managed, celiac disease doesn’t necessarily need to stop women from having babies.

“I would strongly suggest that women with infertility, women having recurrent (miscarriages), girls having delayed onset of menstruation should undergo testing for celiac disease,” said Dr. Govind Makharia, a researcher at the All India Institute of Medical Sciences in New Delhi who wasn’t involved in the study.

Prompt testing is important because if women do have celiac disease, they will have better pregnancy outcomes the sooner they alter their diet to manage the condition, Makharia said by email.

“I must further emphasize that there is no basis or any evidence that women having infertility should start gluten-free diet, without a diagnosis of celiac disease, with a hope that they will conceive and they will have less complicated course of pregnancy,” Makharia cautioned.