Coeliac disease, fertility and pregnancy

Untreated coeliac disease is linked with fertility problems. In research, women with unexplained infertility or recurrent miscarriage have a clearly higher chance of coeliac disease than the general population (PMID 24619876). Often without a single gut complaint.

That makes coeliac disease one of the causes too easily overlooked when trying to conceive. The chain runs through malabsorption: too little iron, folate and other building blocks affects your cycle and an early pregnancy.

The good news: part of that risk recovers after a gluten-free diet. What coeliac disease is exactly is in coeliac disease: symptoms, testing and gluten-free living.

Can coeliac disease affect your fertility?

Yes, untreated coeliac disease can affect your fertility. In a large meta-analysis, women with unexplained infertility had a several-fold higher chance of coeliac disease compared with the general population (PMID 24619876). The disease sat hidden underneath, without clear gut complaints.

The mechanism runs through your gut. Damaged villi absorb less iron, folate and vitamins, and that shortfall affects your hormone balance and your cycle. An irregular or absent period can be a sign.

Important: coeliac disease is one possible factor among many. A broader picture of what you can have investigated when trying to conceive is in fertility testing in women.

Coeliac disease and recurrent miscarriage

Coeliac disease occurs more often in women with recurrent miscarriage. The same meta-analysis found a strongly raised chance of coeliac disease in this group, and in women with untreated coeliac disease a higher risk of miscarriage (PMID 24619876). The antibodies appear able to affect the early placenta.

That does not mean coeliac disease is the cause in everyone with a miscarriage. It is one of the factors that can come into view when there is no other explanation.

Because the disease can run so quietly, it is sometimes found late in this situation. A blood test is then a simple step to rule coeliac disease in or out.

Coeliac disease during pregnancy

In untreated coeliac disease the risk of unfavourable pregnancy outcomes is slightly higher. Think of a lower birth weight, growth restriction and preterm birth (PMID 24619876). In women who follow a gluten-free diet, that risk is lower than in untreated coeliac disease.

A healthy iron and folate status matters in pregnancy anyway. In coeliac disease that uptake is disturbed, which makes it extra worth taking a low iron seriously. See also blood testing during pregnancy.

Which blood values do you test when trying to conceive?

With a suspicion of coeliac disease it starts with Anti-TTG (IgA), supported by Endomysium IgA and Total IgA. When trying to conceive it is also sensible to know your iron and ferritin, because coeliac disease can quietly drain them. Test while you are still eating gluten.

How to read a coeliac result is in coeliac disease blood test: which values say enough. Why iron stays so stubbornly low in coeliac disease is in coeliac disease, iron deficiency and unexplained fatigue.

You can test for coeliac disease or pick individual values through building your own blood test. Discuss an abnormal result with your GP before changing anything in your diet.

What can you do when trying to conceive?

If you are trying to conceive and there are unexplained complaints, a low iron or earlier miscarriages, discuss a coeliac test with your GP. Some women choose to know this beforehand, precisely because a gluten-free diet in coeliac disease can improve the picture.

Do not change your diet on your own before you are tested, because then the test becomes unreliable. The NHG and Thuisarts look at your whole situation with such a question, not at one value. Test first, change after, in consultation with your doctor.

References

1. Tersigni C, Castellani R, de Waure C, et al. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update. 2014;20(4):582-593. PMID 24619876.
2. Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet. 2018;391(10115):70-81. PMID 28760445.
3. Singh P, Arora A, Strand TA, et al. Global Prevalence of Celiac Disease: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836. PMID 29551598.
4. NHG and Thuisarts. Information on coeliac disease, fertility and pregnancy. Available via thuisarts.nl.

Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.