Risk of Morbidity in Contemporary Celiac Disease

Nina R Lewis; Geoffrey KT Holmes

Disclosures

Expert Rev Gastroenterol Hepatol. 2010;4(6):767-780. 

In This Article

Reproductive Problems

Previous studies have raised concern regarding reduced fertility and increased adverse pregnancy-related outcomes in women with celiac disease.[122] Some authors have accepted that infertility is a complication of celiac disease.[123] Reported associations between celiac disease and miscarriage have also added to the concern, although most of the studies have used small, selected populations and have been limited in their ability to adjust for potential confounders.[122,124–129] However, a population-based cohort study using the General Practice Research Database observed that although rates of miscarriage were significantly higher in women with celiac disease in comparison with the general population (rate ratio: 1.31; 95% CI: 1.06–1.61), there was no difference in the risk of stillbirth, nor was there any difference in fertility rates in women with celiac disease (n = 1521) compared with general population controls (fertility rate ratio: 1.01; 95% CI: 0.90–1.14).[130] Age-specific rates demonstrated that female celiacs had lower fertility when younger but higher fertility when older when compared with general population controls. Fertility rate ratios of incident and prevalent female celiacs were similar to the overall analysis and there was no difference between the prevalent and incident groups. Tata et al. speculated that, together with the increase in cesarean section risk amongst celiacs, the age shift in fertility could be reflective of socioeconomic advantages in women with celiac disease.[130] A recent population-based cohort study based on 7416 female celiacs provided further evidence that female celiacs have no difference in fertility in comparison with general population controls.[131] There was also no difference in the proportion of celiacs with one or more live births (87.8 vs 87.6%; p = 0.82) or the number of still births (19.05 still births reported per 1000 total number of reported live and still births) compared with the general population. Women with untreated celiac disease are at greater risk of delivering small babies than those without celiac disease.[132]

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